413-586-7227 Amherst Appraisal

Amherst Appraisal, Inc.
245 Russell St. - Unit 17
The Madison Building
Hadley Park Plaza
Hadley, MA 01035-9558

Telephone: (413) 586-7227
Toll-Free: (800) 428-2188
Fax: (413) 586-8514
office@amherstappraisal.com

Loss Assignment Form

Today's Date: -- mm/dd/yy
Insurance Company:
Insurance Company Tel#:
Agent:
Agent Tel#:
Assigned By:
Tel# + Ext.
Type: Road Assignment Drive-In
Email Address:
Claim Number:
Policy Number:
Date of Loss: -- mm/dd/yy
Insured's Name:
Claimant Name (if applicable):
Address:
City:
State: Zip:
Owner's Home Phone:
Owner's Work Phone:
Year: Make:
Model:
Color:
License Plate #:
VIN#:
Type of Loss:
Location of Vehicle:
Description of Damage: