Appraisal Assignment Form

1

Carrier Claim #* This field is required.Or any identifying name/number for your file.

2

Policyholder Name* This field is required.Your name, if you are the policyholder

First Name

Last Name

3

Your Name* This field is required.Or whoever I am reporting to.

First Name

Last Name

4

Your Company (Or Insurance Carrier)Whoever I am billing my time to.

5

Phone Number* This field is required.Your phone number please for report contact.

Area Code

Phone Number

6

Email* This field is required.Your email please for report contact.

example@example.com

7

Description* This field is required.Please describe the reason for this appraisal request and what the discrepancy is.

Feel free to let me know your stance on the discrepancy, and amounts paid out so far on the claim.

8

Other AppraiserPlease provide name and contact information.

9

File UploadPlease upload all documents pertaining to the appraisal/claim

Drag and drop files here

Select files to upload

Max. file size: 10.6MB