GENERAL INFORMATION
 
 
* Company Name:
 
* Company Address:
 
* Adjuster Name: 
 
* Adjuster Phone & Ext: 
 
* Adjuster Email: 
 
* Type of Loss: 
 
If Other, what type of loss?
 
* Claim Number :
 
* Date of Loss:
 
* General Comments:
* Owner's Name
* Owner's Contact Info.
Appraisal Request