Company Information

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


Claim Information
Assigned To: Appraisal Service of Arkansas, Inc.

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): Amount Written: $ $


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