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New Assignment for Doss & Associates
Your Contact Information
First Name
Last Name
Company
Address (Line 1)
(Line 2)
City
State	AAABAEAKALAPARAZBCCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMBMDMEMIMNMOMSMTNBNCNDNENFNHNJNMNSNUNVNYOHOKONORPAPEPRQCRISCSDSKTNTXUTVAVTWAWIWVWYYT
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New Assignment Information
Your Claim #:
Assignment Instructions: Characters left:
Insured's Information
Policy #:
Phone #:
Alternate Phone #:
Company:
First Name:
Last Name:
Street Address:
Address 2:
City:
State:	AAABAEAKALAPARAZBCCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMBMDMEMIMNMOMSMTNBNCNDNENFNHNJNMNSNUNVNYOHOKONORPAPEPRQCRISCSDSKTNTXUTVAVTWAWIWVWYYT
Zip:
Mortgagee:
Loss Location
Street Address:
Address 2:
City:
State:	AAABAEAKALAPARAZBCCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMBMDMEMIMNMOMSMTNBNCNDNENFNHNJNMNSNUNVNYOHOKONORPAPEPRQCRISCSDSKTNTXUTVAVTWAWIWVWYYT
Zip:
Claimant Information (if applicable)
First Name:
Last Name:
Phone:
Street Address:
Address 2:
City:
State:	AAABAEAKALAPARAZBCCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMBMDMEMIMNMOMSMTNBNCNDNENFNHNJNMNSNUNVNYOHOKONORPAPEPRQCRISCSDSKTNTXUTVAVTWAWIWVWYYT
Zip:
Agent Information Show | Hide
First Name:
Last Name:
Company:
Office Phone:
Cell Phone:
Street Address:
Address 2:
City:
State:	AAABAEAKALAPARAZBCCACOCTDCDEFLGAHIIAIDILINKSKYLAMAMBMDMEMIMNMOMSMTNBNCNDNENFNHNJNMNSNUNVNYOHOKONORPAPEPRQCRISCSDSKTNTXUTVAVTWAWIWVWYYT
Zip:
Country:
Loss Information
Date of Loss:
Type of Loss:	AUTO APPRAISALAUTO PHOTO SCOPE ONLYAUTO SUPPLEMENTAUTO TOTAL LOSS EVALUATIONMOTORCYCLE ATV APPRAISALMOTORCYCLE ATV PHOTO SCOPE ONLYMOTORCYCLE ATV SUPPLEMENTMOTORCYCLE ATV TOTAL LOSS EVALUATIONRV APPRAISALRV PHOTO SCOPE ONLYRV SUPPLEMENTRV TOTAL LOSS EVALUATIONSPECIALTY H/E APPRAISALSPECIALTY H/E PHOTO SCOPE ONLYSPECIALTY H/E TOTAL LOSS EVALUATIONSPECIALTY H/E SUPPLEMENTWATERCRAFT APPRAISALWATERCRAFT PHOTO SCOPE ONLYWATERCRAFT SUPPLEMENTWATERCRAFT TOTAL LOSS EVALUATIONLEASE INSPECTIONAG LINESCOMMERCIAL LINESPERSONAL LINESRISK PHYSICALRISK TELEPHONERISK SITE SURVEYBELOW DONT USE 2.13.21..................................................Total Loss Evaluation*RV Appraisal*Motorcycle Appraisal*Other Appraisal*Lease*Liability*Property*Heavy Equipment*HE Supplement*Work Comp*Photo Scope Auto*Photo Scope Specialty Equipment*Cargo*
Unit:	AUTOCARGOE&SLEASELIABILITYPROPERTYRISKSPECIALTY & HEAVY EQUIPMENT..ITEMS BELOW DONT USE 2.12.21..--------------------------------Appraisal*Auto*Cargo*Commercial*Desk Audit*Farm*Farm Equipment*Fire*General*Hail*Heavy Equipment*Lease Inspection*Lightning*Livestock*Risk - Physical*Risk - Telephone*Risk- Image Survey*Subrogation*Telephone*Wind*Work Comp*Water*Liability*
Type of Adjustment:	Limited Full
Loss Description: Characters left:
VIN #:
Deductible:
Wind Deductible:
Coverage AINDEMNITYADJUSTERS FEESEXPENSESATTORNEY COVERAGE FEESDEFENSE FEESTPA FEESSUBROBodily InjuryLiabilityProperty CoverageProperty Damage
Coverage BINDEMNITYADJUSTERS FEESEXPENSESATTORNEY COVERAGE FEESDEFENSE FEESTPA FEESSUBROBodily InjuryLiabilityProperty CoverageProperty Damage
Coverage CINDEMNITYADJUSTERS FEESEXPENSESATTORNEY COVERAGE FEESDEFENSE FEESTPA FEESSUBROBodily InjuryLiabilityProperty CoverageProperty Damage
Coverage DINDEMNITYADJUSTERS FEESEXPENSESATTORNEY COVERAGE FEESDEFENSE FEESTPA FEESSUBROBodily InjuryLiabilityProperty CoverageProperty Damage
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