PAS Claims

PAS Assignment Sheet

Company Name Date

Adjuster Name Adjuster Phone Number

E-Mail:

Return Address For Appraisals:	City:	State:	Zip Code:

Date of Loss:	Claim #:	Policy #:

Insured:

Insured Address:	City:	State:	Zip Code:

Home Phone:	Work Phone:	Cell Phone:

IV Year:	Make:	Model:	VIN:

Color:	Plate:	Deductible:

Damage:

Vehicle Location:

Phone Number	Contact Name:

Claimant:

Claimant Address:	City:	State:	Zip Code:

Home Phone:	Work Phone:	Cell Phone:

CV Year:	Make:	Model:	VIN:

Color:	Plate:

Damage:

Vehicle Location:

Phone Number:	Contact Name:	Agency Code:

Special Instructions:

Š2007 Precise Appraisal Service. All rights reserved.
Precise Appraisal Service, Inc.
405 Waymont Ct., # 121 - Lake Mary, FL 32746
407-330-1040 | 407-330-3230 Fax
Toll Free 800-848-1420 | 800-481-4631 Fax
info@pasclaims.com