Inland Valley Appraisers
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Assignment Request

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Inland Valley Appraisers.  Hit the SUBMIT button once completed. 
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Insurance Company Name:
Claim Representative:
Phone Number:
Email:
Claim Number:
Policy Number:
Date of Loss:
Loss Type:  (Collision, Comp, PD)
Deductible:
Insured Name:
VEHICLE OWNER INFORMATION:
  Check if Vehicle Owner is Same as Insured
Vehicle Owner:
Street Address:
City:
Zip Code:
Phone (Residence):
Phone (Work):
Phone (Cell):
Vehicle Information
Year:
Make:
Model:
Color:
License Plate:
VIN:
Damage Description:
Vehicle Location:
Loss Facts & Special Instructions:

 

 

 

 

 

 

 

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