• Assigner Name*
• Assigner Email*
• Assigner Phone*
• Assigner Phone Extension
• Client: Name of company requesting services; i.e. Assigner's company*
• Insurance Carrier*
• Date of Loss*
• Is this related to a CAT event?* Yes No
• Cate Event Name
• Claim Number*
• Policy Number*
• Insured's Name*
• Insured's Phone Number 1*
• Insured's Phone Number 2
• Insured's Email
• Address of Risk Location*
• Additional Party Name (for communication and/or scheduling)
• Additional Party Email
• Additional Party Phone
• Describe the scope of the work needed
• Type of damage* (wind, flood, fire, etc.)
• What type of expert do you need?* engineer building consultant fire investigator other unsure
• Areas of the property that need inspected* (roof, interior, exterior, etc.)
• If commercial, how many buildings and/or unit numbers need to be inspected?
• Do you need a call from our expert BEFORE the inspection? Yes No
• Do you need a call from our expert AFTER the inspection? Yes No
• Do you need repair recommendations for storm related damage? Yes No
• Do you need a cost estimate completed by a building consultant if damage is found? Yes No
• If there is a tarp, do we have permission for third party removal? Yes No Provide Quote
• If it’s a tile roof, do you want tile matching information? Yes No
• Is a roof diagram needed? Yes No
• Other Notes/Comments

Attachments:
Accepted file formats: jpg, jpeg, png, doc, docx, pdf, txt.

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