Appraisal Assignment Information Form

This Damage Appraisal Assignment Form is for use by claim adjusters and fleet administrators, and can be used to assign automobile damage appraisals, heavy truck/trailer damage appraisals, motorcycle damage appraisal, RV/mobile home damage appraisals, boat/engine/small craft damage appraisals, construction/agricultural machinery damage appraisals, mechanical inspections and damage appraisals, property damage appraisals, classic/antique/special interest auto damage appraisals, and reinspections (auto body and mechanical repair). When the form has been submitted, it will be electronically forwarded directly to Auto Damage Appraisers Houston.

Company Information

Company Name:
Adjuster's Name:
Phone: Fax:
Adjuster's e-mail:
Address (line 1):
Address (line 2):
City: State/Province:
Zip Code:
Country:

Claim Information


File No.:
Policy No.:
Date of Loss: (MM/DD/YY)
Insured:
Claimant:
Address (line 1):
Address (line 2):
City: State/Province:
Zip Code:
Country:
Home Phone: Bus. Phone:
Vehicle Year: Make:
Vehicle Model: Color:
Vehicle License:
VIN:
COLL PD COMP PROPERTY
Deductible: $
Point of Impact/Loss Description:

Special Instructions:

Vehicle Drivable? Yes No Unknown
Vehicle Location:
Phone:
Shop Estimate(s)? Yes No
Name of Shop(s) and Amount Written:
Shop #1 Name $
Shop #2 Name $

Appraisal Instructions

Obtain Agreed Price With Shop of Owner's Choice
Appraise Damage Only. Do Not Obtain Agreed Price
Other
Photos: 1 To Document Damage As Needed To Document Damage
2 Opposite Corner Prints 4 Corner Prints
Photo Format: 35mm Only Digital Other

Total Loss Instructions

Complete A.C.V. Worksheet at % of Base Book Value (0-100%)
Book Retail Only Average NADA and Dealer Quotes
3 Dealer Cash Selling Quotes Only
Split NADA Retail and Wholesale
Not Applicable (N/A)
Note: Always 4 corner prints for photos. If deduction is made to interior or prior damage, then take close up photo to document.

Salvage Instructions

Estimate Value Only 3 Verbal Bids
Written Bids Not Applicable (N/A)

Move To Pool (Only After Owner's OK)? Yes No
Not Applicable (N/A)

Call Back Instructions

Call Back To: Adjuster Other
If Repairable Loss: Yes No
If Total Loss: Yes No

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