Night Shift Cold Call Assignment
Assignment Source Information
*Adjuster Name
*Company Name
*Adjuster Phone Number
*Adjuster Fax
*Adjuster Address
Adjuster Email Address
File Information
*Adjuster Claim Number
*Insured
*Claimant
*Date of Loss
*Loss Location
*Facts of Loss
Person 1 Assignment Information
Name
Phone
Address
Description
Policy Holder
Insured Driver
Insured Passenger
Claimant Driver
Claimant Passenger
Witness
Other
if other, please specify
Person 1 Vehicle Information
Vehicle Year
Model
Color
Plate Number
Damage Area
Additional Instructions and Comments
-
