Submit Assignment
Adjuster Name
*
Company Name
*
Company Address
*
Please provide full address (either physical or P.O. Box), including City, State, Zip Code.
Adjuster Email
*
Please note, assignments submitted using a Yahoo.com email address may not be received.
Adjuster Phone
*
Please provide direct number or extension.
Claim #
*
Date of Loss
*
Loss Type
*
Please Select
Lightning
Smoke/Fire
Theft/Vandalism
Water
Wear & Tear
Wind
Foreign Object Impact
Power Surge
Unknown
Property Type
*
Residential
Commercial
Property Type
*
Residential
Commercial
Insured First and Last Name or Insured Company Name
*
For Company, please provide a contact name in the Additional Info Section
Insured Phone
*
Multiple phone numbers may be entered, if applicable
Phone Type:
*
Landline
Mobile
Insured Email (Optional):
Preferred Method(s) of Contact (Select ALL That Apply):
*
Phone (Including text/SMS, if applicable)
Email
Loss Address
*
Items To Be Inspected
*
Please indicate items requiring inspection. If only a desktop review is desired, please advise in the field above and upload necessary documents for review below.
Additional Info
Is this an RCV policy?
*
Yes
No
Is this an RCV policy?
*
Yes
No
ZAP Consulting has the authorization to inspect additional electronics/appliances if presented by the insured/claimant:
*
Yes
No - if no, please indicate specific items to be inspected
ZAP Consulting has the authorization to dispatch our HVAC division if heating and air system presented/claimed by insured/claimant? (Note: Electronics and HVAC are billed separately)
*
Yes
No
No, contact adjuster to discuss if HVAC system is claimed
File Upload (Invoices, Estimates, etc...)
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File Upload (Invoices, Estimates, etc..)
Upload a File
Cancel
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File Upload (Invoices, Estimates, etc...)
Upload a File
Cancel
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