New Assignment – Appraisals Plus Inc

New Assignment

Appraisal Request Form

Date

Date of Loss

Company Name

Company Address

Adjuster Name

Email

Phone Number

Claim Number

Name of Insured

Insured Contact

Secondary Contact

Vehicle Make/Model

License Plate #

Vehicle VIN#

Vehicle Location

Vehicle Location Address

Location Phone #

Deductible Amount

Deductible Type

Collision Comprehensive Liability

Insured Pays HST

Yes No

43R Endorsement

Yes No

WOP

Yes No

Accident Details & Damaged Areas