Company Name
Adjusters Name
Phone
Fax
Adjusters Email
 
 
 
Claim Information
Assigned to:
Allstar Appraisals
File #:
Policy #:
Date of Loss:
Insured:
Claimant:
Address (Line 1):
Address (Line 2):
City:
State:
Zip Code:
Country:
Home Phone:
Work Phone:
 
Vehicle Information
Year:
Make:
Model:
Color:
Tag #:
VIN:
Point of Impact / Loss
Special Instructions:
 
 
Vehicle Driveable:

Vehicle Location:
Location Phone:
Shop Estimates:

Name of Shop(s)
 
 
 
 
 
 
Appraisal Instructions
Obtain agreed price with shop of owners choice
Appraise damage only. Do not obtain agreed price.
Other 
 
 
Call Back To:
Adjuster
Other
If repairable loss
Yes No
If total loss:
Yes No