Vehicle Appraisal Assignment

Vehicle Appraisal Only Form

Fields marked with * are required

Customer Information

YOUR FIRST NAME *

COMPANY *

YOUR LAST NAME *

ADDRESS 1 *

WORK PHONE *

ADDRESS 2

CELL PHONE

CITY *

HOME PHONE

STATE *

EMAIL *

ZIP *

TITLE

COUNTRY *

DEPARTMENT

Team Leader Information

FIRST NAME

LAST NAME

PREFERRED PHONE

Claim Information

First Party - Insured

Third Party - Claimant

Both Parties

CLAIM # *

POLICY #

ASSIGNMENT TYPE*

LOSS DATE *

Insured Vehicle Details

VEHICLE YEAR *

LOSS TYPE

VEHICLE MAKE

VIN(last 6 digits)

VECHICLE MODEL *

DRIVEABLE

TOTAL LOSS

POINT OF IMPACT

DEDUCTIBLE

HAS COVERAGE BEEN CONFIRMED?

IS LIABILITY CLEAR?

WOULD YOU LIKE US TO ATTEMPT TO SECURE AN AGREED PRICE?

HAS THE INSURED PROVIDED YOU WITH ANY DAMAGE PHOTOS?

HAS THE INSURED PROVIDED YOU WITH ANY DAMAGE APPRAISALS OR REPAIR INVOICES?

INSTRUCTIONS/COMMENTS*

Insured Details

INSURED TYPE

Person

Business

COMPANY NAME *

FIRST NAME

ADDRESS 1

LAST NAME *
(If insured is unknown, input "UNKNOWN")

ADDRESS 2

WORK PHONE

CITY

CELL PHONE

STATE

HOME PHONE

ZIP

COUNTRY

Insured Vehicle Location Details

LOCATION TYPE

New Location

Same as Insured

LOCATION NAME

ADDRESS 1*

WORK PHONE

ADDRESS 2

CELL PHONE*

CITY *

HOME PHONE

STATE *

ZIP *

COMMENTS

COUNTRY*

Insured Vehicle Owner Details - If Different

FIRST NAME

ADDRESS 1

LAST NAME *

WORK PHONE

ADDRESS 2

CELL PHONE

CITY

HOME PHONE

ZIP

STATE

COUNTRY

Claimant Vehicle Details

VEHICLE YEAR *

LOSS TYPE

VECHICLE MODEL *

VIN(last 6 digits)

VEHICLE MAKE

DRIVEABLE

TOTAL LOSS

POINT OF IMPACT

DEDUCTIBLE

HAS COVERAGE BEEN CONFIRMED?

IS LIABILITY CLEAR?

WOULD YOU LIKE US TO ATTEMPT TO SECURE AN AGREED PRICE?

HAS THE CLAIMANT PROVIDED YOU WITH ANY DAMAGE PHOTOS?

HAS THE CLAIMANT PROVIDED YOU WITH ANY DAMAGE APPRAISALS OR REPAIR INVOICES?

INSTRUCTIONS/COMMENTS*

Claimant Details

CLAIMANT TYPE

Person

Business

COMPANY NAME *

FIRST NAME

ADDRESS 1

LAST NAME *

ADDRESS 2

WORK PHONE

CITY

CELL PHONE

STATE

HOME PHONE

ZIP

COUNTRY

Claimant Vehicle Location Details

LOCATION TYPE

New Location

Same as Claimant

LOCATION NAME

ADDRESS 1*

WORK PHONE

ADDRESS 2

CELL PHONE

CITY *

HOME PHONE

STATE *

ZIP *

COMMENTS

COUNTRY*

Claimant Vehicle Owner Details - if different

FIRST NAME

ADDRESS 1

LAST NAME

WORK PHONE

ADDRESS 2

CELL PHONE

CITY

HOME PHONE

ZIP

STATE

COUNTRY

Assignment Location

LOCATION TYPE

New Location

Same as Insured Vehicle

Same as Claimant Vehicle

ADDRESS*

CITY*

STATE*

ZIP*

COUNTRY *

COMMENTS

Attachments

Individual file size must not exceed 10MB

Please contact Frontier Technical Support at support@frontieradjusters.com.

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