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Serving the Insurance Industry since 1986  
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P O Box 75, 2235 Hwy. 20 East, Fonthill, Ontario L0S 1E0
Telephone: (905) 892-5753 - Toll Free: 1-800-717-4517 - Fax: (905) 892-0920
CONTACT US		  
 
   
  APPRAISAL ASSIGNMENT FOR
ACTION APPRAISAL & CONSULTANTS		  
     
  Please complete the form. Once the form has been sent, the browser will display a confirmation page.

Appraisals are completed as soon as possible, usually the same day as the assignment is received or the following business day.		  
     
 
Date:
Time:
Company:
Address:
Address 2:
City/Town:
Postal Code/Zip:
Adjuster:
Email:
Telephone:
Fax:
Policy Number:
Claim Number:
Date of Loss:

Insured:

Claimant:

Vehicle, Year, Make, Model: 

License Number:

Serial Number:

Body Shop Name:

Address:

Telephone:

Address of Owner:

Owner Phone Number:
Home:
Business:
Cell:
Deductible:
Collision:
Comprehensive:
Waived/None:
Check with adjuster:
Insured pays GST? Yes       No  
Endorsement 43R? Yes       No  
"Without prejudice,
not authorized"		 Yes       No  

Area of damage:
 
Comments:
 
Before you submit this form to Action Appraisal, you may wish to print a
copy for your files.
     
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