Claim Assignments - Accept Claims Online
Vehicle Appraisal

  • Please provide as much information about the claim as possible
  • Required fields are marked by the * symbol and a yellow background.
  • If you do not have the information for a required field, please enter "unknown"
  • Claim Details and Assignment Type
    * Loss Date
    * Claim #
    Policy #

    Insured First Name      Insured Last Name  
    Insured Telephone  

    * Brief Description of Loss 
    * General Assignment Instructions 
    Client Information/Reporting Address
    * Client Company Name
    * First Name
    * Last Name
    Mailing Address
    Building/Suite
    City
    State
    Zip
    * Phone #
    Fax #
    * E-Mail 
    Vehicle #1 Informtion
    * Owner of Vehicle 1  Insured Claimant
    * Owner's First Name
    Middle
    * Last Name
    Company Name
    Address 1
    Address 2
    City
    State
    Zip
    * Phone #
    Other Phone #
    Fax #
    * Location/POI/Damage 
    * Notes/Special Instructions 
    * Vehicle Type
    * Vehicle Make
    * Color
    * Yr
    * Model
    * VIN
    * Plate
    * Driveable?
       Yes    No
    * Are there additional vehicles to report?   Yes    No