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Property Assignment Form

*Note: All fields marked with an asterisk (*) are required.

Adjuster Information

Adjuster NameInsurance CompanyMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressDOLClaim NumberPolicy NumberDeductible

Insured Information

First NameLast nameMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressDamage Description

Claimant Information

First NameLast NameMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressDamage Description

Instructions

Other Special InstructionsDo you want us to reach an agreed price with the insured/claimant?Yes
No - this is an appraisal onlyDo you want us to confirm the cause of your loss?Yes
NoHow do you prefer we return assignments to you?Email
Mail
Fax

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Attachments

Attachment 1Attachment 2Attachment 3

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Enter your email address below
*Contact Email

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Intermountain Service Areas

Idaho Service Area
We provide WC and P&C services throughout all of Idaho

Montana Service Area
We provide WC services throughout all of Montana

Oregon Service Area
We provide WC and P&C services in Portland, E. Oregon, and the surrounding areas

Utah Service Area
We provide WC and P&C services throughout all of Utah

Washington Service Area
We provide WC services throughout all of Washington and P&C services in Spokane, Yakima, E. Washington, and the surrounding areas

See the Area Map of our service coverage.

Services

Property & Casualty
Third-Party Administration
Auto Appraisals
Truck/Heavy Equipment
Bodily Injury & Casualty
Construction Defect
Mediation & Arbitration
Workers’ Compensation
Specialty Services

Links

State of Idaho
State of Utah
Idaho Industrial Commission
National Weather Service
Oregon Workers Compensation
Washington Self Insurers Association
The Claims Page
American Red Cross - Disaster Services
National Truck & Heavy Equipment Claims
A.M. Best
More Links