P.O. Box 293624 Sacramento, CA 95829 Office - 916-760-7598 Fax - 888-760-1953 info@carscalifornia.com
Assignment Form
General Information
Claim Representative
Insurance Company
Phone (include area code)
Fax
Email Address
Claim Number
Policy Number
Type of Assignment
Appraisal & Photo Photo Only Scene Investigation Estimate Audit Other Explain Below
If Other, Please Explain
Date of Loss
Type of Loss
Collision Property Damage Comprehensive Recovered Theft Fire
Deductible
Insured Information
Name
Phone
Phone 2
Phone 3
Street Address
City
Zip
Claimant Information
Vehicle Information
Vehicle Year
Vehicle Make
Vehicle Model
Vehicle ID
Vehicle Color
Vehicle License
Vehicle Location
Location Phone (include area code)
Primary Impact Area
Secondary Impact Area
Total Loss
Yes No Unknown
If total loss what are the instructions?
Please type special instructions here.
Repair Facility Choice
Please type complete address in this space
Repair Facility Phone (include area code)
Estimate Amount
Other Estimates
Description of loss and other instructions
