Assignment page


Drop Assignment to assignments@collisionrepairadvice.com

For any typ of claim PDF the file with all the information that you have and need done. I am a full multi line adjuster.

Thank you,
Marc
New Assignment Form

Fields marked with * are required

Customer Information

YOUR FIRST NAME*

YOUR LAST NAME*

TITLE

COMPANY*

DEPARTMENT

ADDRESS*

ADDRESS 2

CITY*

–State–Alabama (AL )Alaska (AK )Alberta (AB )Arizona (AZ )Arkansas (AR )Bratislava (BRAT )British Columbia (BC )California (CA )Colorado (CO )Connecticut (CT )Delaware (DE )District of Columbia (DC )England (ENG )Florida (FL )Georgia (GA )Germany (DE )Hawaii (HI )Idaho (ID )Illinois (IL )Indiana (IN )Iowa (IA )Kansas (KS )Kentucky (KY )London (LD )Louisiana (LA )Maine (ME )Manitoba (MB )Maryland (MD )Massachusetts (MA )Michigan (MI )Milano (I-MI )Minnesota (MN )Mississauga (MISSI )Mississippi (MS )Missouri (MO )Montana (MT )Nebraska (NE )Nevada (NV )New Brunswick (NB )New Hampshire (NH )New Jersey (NJ )New Mexico (NM )New York (NY )Newfoundland and Labrador (NL )North Carolina (NC )North Dakota (ND )Northwest Territories (NT )Nova Scotia (NS )Nunavut (NU )Ohio (OH )Oklahoma (OK )Ontario (ON )Oregon (OR )Pennsylvania (PA )Prince Edward Island (PE )Prince Edward Island (PE )Quebec (QC )Regina (RG )Rhode Island (RI )Saskatchewan (SK )Singapore (SG )Slovak Republic (SK )South Carolina (SC )South Dakota (SD )Tennessee (TN )Texas (TX )Utah (UT )Vermont (VT )Virginia (VA )Washington (WA )West Virginia (WV )Wisconsin (WI )Wyoming (WY )Yorkton (YK )Yukon (YT )Yukon (YT )STATE*

ZIP*

-Select a Country-United States (USA )Canada (CAN )Mexico (MEX )Germany (DE )Singapore (SG )United Kingdom (UK )Italy (ITALY )France (FR )Europe (EU )Slovakia (SLOV )COUNTRY *

PHONE #*

EXT

FAX #

EMAIL*

YOUR CLAIM #*

DATE OF ACCIDENT/LOSS*

Insured

INSURED TYPE
Person

Business

INSURED FIRST NAME

INSURED LAST NAME*

ADDRESS

CITY

–State–Alabama (AL )Alaska (AK )Alberta (AB )Arizona (AZ )Arkansas (AR )Bratislava (BRAT )British Columbia (BC )California (CA )Colorado (CO )Connecticut (CT )Delaware (DE )District of Columbia (DC )England (ENG )Florida (FL )Georgia (GA )Germany (DE )Hawaii (HI )Idaho (ID )Illinois (IL )Indiana (IN )Iowa (IA )Kansas (KS )Kentucky (KY )London (LD )Louisiana (LA )Maine (ME )Manitoba (MB )Maryland (MD )Massachusetts (MA )Michigan (MI )Milano (I-MI )Minnesota (MN )Mississauga (MISSI )Mississippi (MS )Missouri (MO )Montana (MT )Nebraska (NE )Nevada (NV )New Brunswick (NB )New Hampshire (NH )New Jersey (NJ )New Mexico (NM )New York (NY )Newfoundland and Labrador (NL )North Carolina (NC )North Dakota (ND )Northwest Territories (NT )Nova Scotia (NS )Nunavut (NU )Ohio (OH )Oklahoma (OK )Ontario (ON )Oregon (OR )Pennsylvania (PA )Prince Edward Island (PE )Prince Edward Island (PE )Quebec (QC )Regina (RG )Rhode Island (RI )Saskatchewan (SK )Singapore (SG )Slovak Republic (SK )South Carolina (SC )South Dakota (SD )Tennessee (TN )Texas (TX )Utah (UT )Vermont (VT )Virginia (VA )Washington (WA )West Virginia (WV )Wisconsin (WI )Wyoming (WY )Yorkton (YK )Yukon (YT )Yukon (YT )STATE

ZIP

-Select a Country-United States (USA )Canada (CAN )Mexico (MEX )Germany (DE )Singapore (SG )United Kingdom (UK )Italy (ITALY )France (FR )Europe (EU )Slovakia (SLOV )COUNTRY

PHONE 1 #

Cell

Home

Work

PHONE 2 #

Cell

Home

Work

EMAIL

Claimant

CLAIMANT TYPE
Person

Business

ClAIMANT FIRST NAME

CLAIMANT LAST NAME

ADDRESS

CITY

–State–Alabama (AL )Alaska (AK )Alberta (AB )Arizona (AZ )Arkansas (AR )Bratislava (BRAT )British Columbia (BC )California (CA )Colorado (CO )Connecticut (CT )Delaware (DE )District of Columbia (DC )England (ENG )Florida (FL )Georgia (GA )Germany (DE )Hawaii (HI )Idaho (ID )Illinois (IL )Indiana (IN )Iowa (IA )Kansas (KS )Kentucky (KY )London (LD )Louisiana (LA )Maine (ME )Manitoba (MB )Maryland (MD )Massachusetts (MA )Michigan (MI )Milano (I-MI )Minnesota (MN )Mississauga (MISSI )Mississippi (MS )Missouri (MO )Montana (MT )Nebraska (NE )Nevada (NV )New Brunswick (NB )New Hampshire (NH )New Jersey (NJ )New Mexico (NM )New York (NY )Newfoundland and Labrador (NL )North Carolina (NC )North Dakota (ND )Northwest Territories (NT )Nova Scotia (NS )Nunavut (NU )Ohio (OH )Oklahoma (OK )Ontario (ON )Oregon (OR )Pennsylvania (PA )Prince Edward Island (PE )Prince Edward Island (PE )Quebec (QC )Regina (RG )Rhode Island (RI )Saskatchewan (SK )Singapore (SG )Slovak Republic (SK )South Carolina (SC )South Dakota (SD )Tennessee (TN )Texas (TX )Utah (UT )Vermont (VT )Virginia (VA )Washington (WA )West Virginia (WV )Wisconsin (WI )Wyoming (WY )Yorkton (YK )Yukon (YT )Yukon (YT )STATE

ZIP

-Select a Country-United States (USA )Canada (CAN )Mexico (MEX )Germany (DE )Singapore (SG )United Kingdom (UK )Italy (ITALY )France (FR )Europe (EU )Slovakia (SLOV )COUNTRY

PHONE 1 #

Cell

Home

Work

PHONE 2 #

Cell

Home

Work

EMAIL

Assignment

TYPE OF ASSIGNMENT*Select Assignment TypeCargoCasualtyPropertyWorkers’ Compensation

LOSS DESCRIPTION*

LOSS LOCATION*
New Location

Same as Insured

ADDRESS*

CITY*

–State–Alabama (AL )Alaska (AK )Alberta (AB )Arizona (AZ )Arkansas (AR )Bratislava (BRAT )British Columbia (BC )California (CA )Colorado (CO )Connecticut (CT )Delaware (DE )District of Columbia (DC )England (ENG )Florida (FL )Georgia (GA )Germany (DE )Hawaii (HI )Idaho (ID )Illinois (IL )Indiana (IN )Iowa (IA )Kansas (KS )Kentucky (KY )London (LD )Louisiana (LA )Maine (ME )Manitoba (MB )Maryland (MD )Massachusetts (MA )Michigan (MI )Milano (I-MI )Minnesota (MN )Mississauga (MISSI )Mississippi (MS )Missouri (MO )Montana (MT )Nebraska (NE )Nevada (NV )New Brunswick (NB )New Hampshire (NH )New Jersey (NJ )New Mexico (NM )New York (NY )Newfoundland and Labrador (NL )North Carolina (NC )North Dakota (ND )Northwest Territories (NT )Nova Scotia (NS )Nunavut (NU )Ohio (OH )Oklahoma (OK )Ontario (ON )Oregon (OR )Pennsylvania (PA )Prince Edward Island (PE )Prince Edward Island (PE )Quebec (QC )Regina (RG )Rhode Island (RI )Saskatchewan (SK )Singapore (SG )Slovak Republic (SK )South Carolina (SC )South Dakota (SD )Tennessee (TN )Texas (TX )Utah (UT )Vermont (VT )Virginia (VA )Washington (WA )West Virginia (WV )Wisconsin (WI )Wyoming (WY )Yorkton (YK )Yukon (YT )Yukon (YT )STATE*

ZIP*

-Select a Country-United States (USA )Canada (CAN )Mexico (MEX )Germany (DE )Singapore (SG )United Kingdom (UK )Italy (ITALY )France (FR )Europe (EU )Slovakia (SLOV )COUNTRY *

ASSIGNMENT

(What do you want Frontier to do?)
*

ASSIGNMENT LOCATION
Same as Loss Location

Same as Insured

Same as Claimant

ADDRESS*

CITY*

–State–Alabama (AL )Alaska (AK )Alberta (AB )Arizona (AZ )Arkansas (AR )Bratislava (BRAT )British Columbia (BC )California (CA )Colorado (CO )Connecticut (CT )Delaware (DE )District of Columbia (DC )England (ENG )Florida (FL )Georgia (GA )Germany (DE )Hawaii (HI )Idaho (ID )Illinois (IL )Indiana (IN )Iowa (IA )Kansas (KS )Kentucky (KY )London (LD )Louisiana (LA )Maine (ME )Manitoba (MB )Maryland (MD )Massachusetts (MA )Michigan (MI )Milano (I-MI )Minnesota (MN )Mississauga (MISSI )Mississippi (MS )Missouri (MO )Montana (MT )Nebraska (NE )Nevada (NV )New Brunswick (NB )New Hampshire (NH )New Jersey (NJ )New Mexico (NM )New York (NY )Newfoundland and Labrador (NL )North Carolina (NC )North Dakota (ND )Northwest Territories (NT )Nova Scotia (NS )Nunavut (NU )Ohio (OH )Oklahoma (OK )Ontario (ON )Oregon (OR )Pennsylvania (PA )Prince Edward Island (PE )Prince Edward Island (PE )Quebec (QC )Regina (RG )Rhode Island (RI )Saskatchewan (SK )Singapore (SG )Slovak Republic (SK )South Carolina (SC )South Dakota (SD )Tennessee (TN )Texas (TX )Utah (UT )Vermont (VT )Virginia (VA )Washington (WA )West Virginia (WV )Wisconsin (WI )Wyoming (WY )Yorkton (YK )Yukon (YT )Yukon (YT )STATE*

ZIP*

-Select a Country-United States (USA )Canada (CAN )Mexico (MEX )Germany (DE )Singapore (SG )United Kingdom (UK )Italy (ITALY )France (FR )Europe (EU )Slovakia (SLOV )COUNTRY *

COMMENTS

Injury / Damage / Coverage

INJURY/DAMAGE

COVERAGE INFORMATION

Attachments

Individual file size must not exceed 10MB