Auto Assignment Form

*Note: All fields marked with an asterisk (*) are required.
Adjuster NameInsurance CompanyMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressDOLClaim NumberPolicy NumberDeductibleFirst NameLast NameMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressYearMakeModelVINDamage Description Vehicle LocationIs the vehicle a total loss?
CCC, ADP, or Dealer Quotes

Do you want us to move salvage?
If so, where to? NameMailing AddressBuilding/SuiteCityStateZip codePhone NumberFirst NameLast NameMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressYearMakeModelVehicle LocationDamage DescriptionIs the vehicle a total loss?
CCC, ADP, or get dealer quotes

Do you want us to phone in the evaluation?
Do you want us to move the salvage?
If so, where to? NameMailing addressBuilding/SuiteCityStateZipPhone numberOther Special InstructionsHow do you prefer we return assignments to you?


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Intermountain Service Areas

Idaho Service Area
We provide WC and P&C services throughout all of Idaho

Montana Service Area
We provide WC services throughout all of Montana and P&C services in Missoula and the surrounding areas

Oregon Service Area
We provide WC and P&C services in Portland, E. Oregon, and the surrounding areas

Utah Service Area
We provide WC and P&C services throughout all of Utah

Washington Service Area
We provide WC services throughout all of Washington and P&C services in Yakima, E. Washington, and the surrounding areas

See the Area Map of our service coverage.