Central Valley Auto Appraising - E-mail Claim to CVAA


Company Information:
Company Name:
Adjuster's Name:
Phone Number:	Ext.:
Fax Number:
Adjuster's E-mail:
Company Address:
Address (Line 2):
City:		State:	Zip Code:

Claim Information:
Claim Number:		Policy Number:
Date of Loss:
Insured:
Claimant:

Owner's Information:
Owner's Name:
Address:
Address (Line 2):
City:		State:	Zip Code:
Home Phone:
Work Phone:	Ext.:
Cell Phone:

Vehicle Information:
Year:		Make:
Model:		License:
VIN:		Color:
Vehicle Drivable?	Yes No Unknown
Location (Name):
Address:
Address (Line 2):
City:		State:	Zip Code:
Location Phone:
Shop Estimate:	$

Loss Information:
Type of Loss:	Collision Liability Comprehensive Property Other
Deductible:	$
Point of Impact/Loss Description:

Special Instructions:

Total Loss Instructions:


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