Appraisalserviceofms.com Appraisal Assignment Request
Property

You can send us an assignment by filling in the form below.
Please provide as much information as possible.
Your request will be processed immediately.

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Company Name:
Contact Name:
Adjuster Dispatcher Other
Phone: (include area code)
E-mail:
Fax: (include area code)
Sent Confirmation by: E-mail Fax

Type of Assignment:
Claim Number:
Policy Number:
Deductible: (put dollar amount only, 0 if none)
Date of Loss: (mm/dd/yy)
Type of Loss:

Type of Claim: Insured Claimant
Insured First/Last Name:
Address:
City:
State / Zip:
Home Phone:
Work Phone:
Claimant First/Last Name:
Address:
City:
State / Zip:
Home Phone:
Work Phone:

Property Info
Contact First Name:
Contact Last Name:
Coverage:
Contact Phone:
Contact Work Phone/Ext:
Contact Cell Phone:
Description of Loss:

Special Instructions: