Specialty Adjusting Services & Specialty Adjusting International

 divisions of:

                     Viamontes Enterprises, Inc.                    

Thank you for the assignment.  It has been sent to Specialty Adjusting. If you do not receive a confirmation notice via email, fax or phone within 24 hours, please call us at (561) 747-0004.

You may print this page for your records.

Today's Date:     

 Company Name:            Address:             

Adjuster's Name:               

Adjuster's Email:      Adjuster's Phone:

Insured:           

 

Insured Contact:       

Address:  , ,    

Insured Telephone 

Claim/Policy Number        Date of Loss
Claimant  Information    

      

Claimant Address: :    :   : 

Phone 

        Description of Assignment/Request: 

    HOMEOWNER POLICY INFORMATION:

COVERAGE:                                                          RESERVES:

       
$ Dwelling $
$ Appurtenant Private Structure $
$ Unscheduled Personal Property $
$ Additional Living Expense $
$ Deductible

Coinsurance:  % 

Policy Form No(s):  
      

COMMERCIAL POLICY INFORMATION:

 
 COVERAGE:                                               RESERVES:
       
$ Building $
$ Business Personal Property $
$ Loss of Revenue $
         
$ Deductible

Coinsurance: % 

POLICY FORMS: Basic  
  Special  
  Broad  
Endorsements:
        

PLEASE FAX POLICE REPORT and/or  DOCUMENTS TO:  561-747-0022 

You plan to  FAX Police Report or other documents:

Items to be Faxed:   Police Report    Acord Form:    Other Documents:  

 

TO SEND ANOTHER ASSIGNMENT PLEASE CLICK HERE