Assignment Form – Indemnity Consulting

A Reputation Built On Delivery

For assignments, please use the form below:

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Comments

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Your Contact Information

First Name*

Last Name*

Company*

Title*

Contact Phone Number*

Contact Email Address*

Are you a new or existing client?*

NEW

EXISTING

Services Requested (Click all that apply)*

Property Damage Assessment

Repair Scope Assessment

Schedule Analysis

Expert Testimony & Litigation Support

Bid Package Development & Review

Cost Estimating

Code Upgrade Analysis

Invoice Auditing

Appraisal & Umpire Services

Project Status Assessment

Thermal Imaging Service

Structure Type

Project Type

Insured Name*

Type of Peril

Insured Contact Number

Insured Email Address

Claim Number

Policy Number

Insurance Carrier*

Examiner Name

Examiner E-mail

IA Firm (If Applicable)

IA File #

Loss Location

You can add up to 5

Number of Locations

Location 1

Loss Address*

Loss City*

Loss State

Loss Zip Code*

Location 2

Loss Address*

Loss City*

Loss State

Loss Zip Code*

Location 3

Loss Address*

Loss City*

Loss State

Loss Zip Code*

Location 4

Loss Address*

Loss City*

Loss State

Loss Zip Code*

Location 5

Loss Address*

Loss City*

Loss State

Loss Zip Code*

Date of Loss

MM slash DD slash YYYY

Additional Instructions, Project Contacts, Information, etc.

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