Assignment Form

Carrier Information

Carrier

Location

Type of Assignment

Send Adjuster Notification

Adjuster First Name

Adjuster Last Name

Adjuster Email

Adjuster Phone

Phone Ext.

Claim Information

File Number

New Assignment

Claim Number

Policy Number

Loss Date

Deductible

UNK

WAIVED

Email Received

January 2025
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Time picker
Time Picker
12:00 AM	1:00 AM	2:00 AM
3:00 AM	4:00 AM	5:00 AM
6:00 AM	7:00 AM	8:00 AM
9:00 AM	10:00 AM	11:00 AM
12:00 PM	1:00 PM	2:00 PM
3:00 PM	4:00 PM	5:00 PM
6:00 PM	7:00 PM	8:00 PM
9:00 PM	10:00 PM	11:00 PM

DOI/DRP

Yes

Total Loss

Yes

CAT Claim

Yes

SDU

Multiple Units

Multiple

Loss Code

Assignment Description

Contact/Owner Information

Company Name

Insured or Claimant

Insured

Claimant

First Name

Last Name

Address

Zip

City

State

Home Number

Cell Number

Other Number

Work Number

Apply Information To

Insured Claimant Location

Insured Information

Company Name

First Name

Last Name

Address

Zip

City

State

Home Number

Cell Number

Other Number

Work Number

Claimant Information

Company Name

First Name

Last Name

Address

Zip

City

State

Home Number

Cell Number

Other Number

Work Number

Vehicle

Year

Make

Model

VIN

Type

Color

Mileage

Drivable

Plate State

Plate Number

Area of Damage:

Delivery Instructions:

Shop Information

Shop By TaxID

Select Type

Select Location

Location Name

First Name

Address1

Zip

State

Work Number

Fax Number

Copy In

Vehicle Location

Select Facility

Select Contact

Tax ID

Last Name

Address2

City

Shop Type

Cell Number

Vehicle Location Information

Location Name

Use for Mileage

First Name

Last Name

Address1

Address2

Zip

City

State

Type

Home Number

Work Number

Cell Number

Other Number

Companion Main File

Companion File Number

You must add a claim number
You must select Insured or Claimant
You must add a Loss Date
You must add a Location Address
You must add a Location City
You must add a Location Zip
You must add a Location State

Triage

* If one of these items is selected, file is not eligible for Streamline

Did the front or side curtain airbags deploy

Is the vehicle non-drivable

Undercarriage/Mechanical/Sever damage /Leaking Fluids / Total loss

Is an entire side of the vehicle damaged from front to rear

Shop/Tow Yard/Copart

Is the vehicle damage from hail, flood, fire, theft, measure photos or roll over

Carrier Requested Physical Inspection

Carrier Requested Streamline

Shop DNU

Shop - DNU	Address	City	State	Zip	Phone

Duplicate Check

Claim #	File #	Date Entered	Loss Date	Vehicle	Insured	Claimant

Dispatch

Auto Dispatch

Send to Dispatch

Do Not Call

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6	2	3	4	5	6	7	8

Add these Profiles to	ACV No Inspection (List Valuation Type) \| All Specialty Vehicles ACV No Inspection (List Valuation type) \| Std Auto Only ACV with Inspection (List Valuation type) \| All Specialty Vehicles ACV with Inspection (List Valuation type) \| Std Auto Only Appraisal Clause for Damage Estimate \| All Vehicle and Property Types Appraisal Clause for Diminished Value \| All Vehicle and Property Types Appraisal Clause for T/L Value \| All Vehicle and Property Types Cargo/Freight Inspection \| Other or Unknown Vehicle or Property Cold Call Inspection Contents Inspection \| Residential Property Court Appearance \| Intangible Inspection (No vehicle or property – Scene or location only) Desk Estimate Review \| ATV/Golf Cart/Snowmobile Desk Estimate Review \| Auto/Light Truck Custom/Classic/Exotic (Non-database) Desk Estimate Review \| Auto/Light Truck Standard (Private Passenger) Desk Estimate Review \| Boat/Watercraft Desk Estimate Review \| Heavy Duty Trailer Desk Estimate Review \| Heavy Duty Truck Desk Estimate Review \| Heavy Equipment – Off-Road Construction Vehicles or Equipment Desk Estimate Review \| Heavy Equipment – Off-Road Farm/Forestry Vehicles or Equipment Desk Estimate Review \| Light Duty Trailer Desk Estimate Review \| Medium Duty Truck Desk Estimate Review \| Motorcycle Custom/Classic (Non-Database) Desk Estimate Review \| Motorcycle Stock (Database) Desk Estimate Review \| Other or Unknown Vehicle or Property Desk Estimate Review \| Personal Property (Bicycles, Wheelchairs) Desk Estimate Review \| Recreational Vehicles (RV, Travel Trailer, Camper) Desk Estimate Review \| Residential Property Desk Estimate Write \| ATV/Golf Cart/Snowmobile Desk Estimate Write \| Auto/Light Truck Custom/Classic/Exotic (Non-database) Desk Estimate Write \| Auto/Light Truck Standard (Private Passenger) Desk Estimate Write \| Boat/Watercraft Desk Estimate Write \| Heavy Duty Trailer Desk Estimate Write \| Heavy Duty Truck Desk Estimate Write \| Heavy Equipment – Off-Road Construction Vehicles or Equipment Desk Estimate Write \| Heavy Equipment – Off-Road Farm/Forestry Vehicles or Equipment Desk Estimate Write \| Light Duty Trailer Desk Estimate Write \| Medium Duty Truck Desk Estimate Write \| Motorcycle Custom/Classic (Non-Database) Desk Estimate Write \| Motorcycle Stock (Database) Desk Estimate Write \| Other or Unknown Vehicle or Property Desk Estimate Write \| Personal Property (Bicycles, Wheelchairs) Desk Estimate Write \| Recreational Vehicles (RV, Travel Trailer, Camper) Desk Estimate Write \| Residential Property Desk Subro Review No Negotiation \| ATV/Golf Cart/Snowmobile Desk Subro Review No Negotiation \| Auto/Light Truck Custom/Classic/Exotic (Non-database) Desk Subro Review No Negotiation \| Auto/Light Truck Standard (Private Passenger) Desk Subro Review No Negotiation \| Boat/Watercraft Desk Subro Review No Negotiation \| Commercial Light Duty (F350 and below) Desk Subro Review No Negotiation \| Heavy Duty Trailer Desk Subro Review No Negotiation \| Heavy Duty Truck Desk Subro Review No Negotiation \| Heavy Equipment – Off-Road Construction Vehicles or Equipment Desk Subro Review No Negotiation \| Heavy Equipment – Off-Road Farm/Forestry Vehicles or Equipment Desk Subro Review No Negotiation \| Light Duty Trailer Desk Subro Review No Negotiation \| Medium Duty Truck Desk Subro Review No Negotiation \| Motorcycle Custom/Classic (Non-Database) Desk Subro Review No Negotiation \| Motorcycle Stock (Database) Desk Subro Review No Negotiation \| Other or Unknown Vehicle or Property Desk Subro Review No Negotiation \| Personal Property (Bicycles, Wheelchairs) Desk Subro Review No Negotiation \| Recreational Vehicles (RV, Travel Trailer, Camper) Desk Subro Review No Negotiation \| Residential Property Desk Subro Review with Negotiation \| All Vehicle and Property Types Diminished Value with Inspection \| All Vehicle and Property Types Diminished Value without Inspection \| All Vehicle and Property Types DOI Reinspection \| All Vehicle and Property Types DRP/Open Shop Audit Reinspection with Estimate Revision \| Auto/Light Truck Standard (Private Passen DRP/Open Shop Audit Reinspection without Estimate Revision \| Auto/Light Truck Standard (Private Pas Flood Inspection and Estimate \| Auto/Light Truck Custom/Classic/Exotic (Non-database) Flood Inspection and Estimate \| Auto/Light Truck Premium (Database) Flood Inspection and Estimate \| Auto/Light Truck Standard (Private Passenger) Flood Inspection and Estimate \| Commercial Light Duty (F350 and below) Flood Inspection and Estimate \| Heavy Duty Trailer Flood Inspection and Estimate \| Heavy Equipment – Off-Road Construction Vehicles or Equipment Flood Inspection and Estimate \| Light Duty Trailer Flood Inspection and Estimate \| Medium Duty Truck Flood Inspection and Estimate \| Motorcycle Custom/Classic (Non-Database) Flood Inspection and Estimate \| Motorcycle Stock (Database) Flood Inspection and Estimate \| Other or Unknown Vehicle or Property Flood Inspection and Estimate \| Personal Property (Bicycles, Wheelchairs) Flood Inspection and Estimate \| Recreational Vehicles (RV, Travel Trailer, Camper) Flood Inspection and Estimate \| Residential/Commercial Property (Building, Signs, Walls, Landscape Fuel/Oil Sample Only \| All Vehicle and Property Types Generic/Temporary Desk Profile \| All Vehicles Types Generic/Temporary Field Profile \| All Vehicles Types Hail Inspection and Estimate \| Auto/Light Truck Custom/Classic/Exotic (Non-database) Hail Inspection and Estimate \| Auto/Light Truck Premium (Database) Hail Inspection and Estimate \| Auto/Light Truck Standard (Private Passenger) Hail Inspection and Estimate \| Boat/Watercraft Hail Inspection and Estimate \| Commercial Light Duty (F350 and below) Hail Inspection and Estimate \| Heavy Duty Trailer Hail Inspection and Estimate \| Heavy Duty Truck Hail Inspection and Estimate \| Heavy Equipment – Off-Road Construction Vehicles or Equipment Hail Inspection and Estimate \| Motorcycle Custom/Classic (Non-Database) Hail Inspection and Estimate \| Motorcycle Stock (Database) Hail Inspection and Estimate \| Other or Unknown Vehicle or Property Hail Inspection and Estimate \| Recreational Vehicles (RV, Travel Trailer, Camper) Mechanical Inspection and Estimate (Fuel Contam., Engine Fires, Mechanical Losses) \| All Vehicles Photo and ID Vehicle \| All Specialty Vehicles Photo and ID Vehicle \| Std Auto / EV Only Photo, ID and Scope Damage \| ATV/Golf Cart/Snowmobile Photo, ID and Scope Damage \| Auto/Light Truck Custom/Classic/Exotic (Non-database) Photo, ID and Scope Damage \| Auto/Light Truck Premium (Database) Photo, ID and Scope Damage \| Auto/Light Truck Standard (Private Passenger) Photo, ID and Scope Damage \| Boat/Watercraft Photo, ID and Scope Damage \| Commercial Light Duty (F350 and below) Photo, ID and Scope Damage \| Heavy Duty Trailer Photo, ID and Scope Damage \| Heavy Duty Truck Photo, ID and Scope Damage \| Heavy Equipment – Off-Road Construction Vehicles or Equipment Photo, ID and Scope Damage \| Heavy Equipment – Off-Road Farm/Forestry Vehicles or Equipment Photo, ID and Scope Damage \| Light Duty Trailer Photo, ID and Scope Damage \| Medium Duty Truck Photo, ID and Scope Damage \| Motorcycle Custom/Classic (Non-Database) Photo, ID and Scope Damage \| Motorcycle Stock (Database) Photo, ID and Scope Damage \| Other or Unknown Vehicle or Property Photo, ID and Scope Damage \| Personal Property (Bicycles, Wheelchairs) Photo, ID and Scope Damage \| Recreational Vehicles (RV, Travel Trailer, Camper) Photo, ID and Scope Damage \| Residential/Commercial Property (Building, Signs, Walls, Landscape etc) Police Report Pickup \| Intangible Inspection (No vehicle or property – Scene or location only) Repair Quality Reinspection \| All Vehicle and Property Types Salvage Bids \| ATV/Golf Cart/Snowmobile Salvage Bids \| Auto/Light Truck Custom/Classic/Exotic (Non-database) Salvage Bids \| Auto/Light Truck Premium (Database) Salvage Bids \| Auto/Light Truck Standard (Private Passenger) Salvage Bids \| Boat/Watercraft Salvage Bids \| Commercial Light Duty (F350 and below) Salvage Bids \| Heavy Duty Trailer Salvage Bids \| Heavy Duty Truck Salvage Bids \| Heavy Equipment – Off-Road Construction Vehicles or Equipment Salvage Bids \| Heavy Equipment – Off-Road Farm/Forestry Vehicles or Equipment Salvage Bids \| Light Duty Trailer Salvage Bids \| Medium Duty Truck Salvage Bids \| Motorcycle Custom/Classic (Non-Database) Salvage Bids \| Motorcycle Stock (Database) Salvage Bids \| Other or Unknown Vehicle or Property Salvage Bids \| Personal Property (Bicycles, Wheelchairs) Salvage Bids \| Recreational Vehicles (RV, Travel Trailer, Camper) Salvage Movement \| All Vehicle and Property Types Scene Investigation \| Intangible Inspection (No vehicle or property – Scene or location only) Special CAT Profile (Use for specific or large-scale CAT events only) \| All Vehicle and Property Ty Special Desk Service \| All Vehicle and Property Types Special Field Service \| All Vehicle and Property Types Standard Inspection & Estimate \| ATV/Golf Cart/Snowmobile Standard Inspection & Estimate \| Auto/Light Truck Custom/Classic/Exotic Standard Inspection & Estimate \| Auto/Light Truck Standard (Private Passenger) Standard Inspection & Estimate \| Auto/Light Truck Standard Electric Vehicle Standard Inspection & Estimate \| Boat/Watercraft Standard Inspection & Estimate \| Heavy Duty Trailer Standard Inspection & Estimate \| Heavy Equipment Standard Inspection & Estimate \| Medium/Heavy Duty Truck Standard Inspection & Estimate \| Motorcycle Custom/Classic (Non-Database) Standard Inspection & Estimate \| Motorcycles Standard Inspection & Estimate \| Other or Unknown Vehicle or Property Standard Inspection & Estimate \| Personal Property (Bicycles, Wheelchairs) Standard Inspection & Estimate \| Recreational Vehicles (RV, Travel Trailer, Camper) Standard Inspection & Estimate \| Residential Property Streamline Virtual Service \| ATV/Golf Cart/Snowmobile Streamline Virtual Service \| Auto/Light Truck Custom/Classic/Exotic (Non-database) Streamline Virtual Service \| Auto/Light Truck Standard (Private Passenger) Streamline Virtual Service \| Boat/Watercraft Streamline Virtual Service \| EV Only Streamline Virtual Service \| Heavy Duty Trailer Streamline Virtual Service \| Heavy Equipment Streamline Virtual Service \| Heavy Equipment – Off-Road Farm/Forestry Vehicles or Equipment Streamline Virtual Service \| Intangible Inspection (No vehicle or property – Scene or location only Streamline Virtual Service \| Light Duty Trailer Streamline Virtual Service \| Medium Duty Truck Streamline Virtual Service \| Medium/Heavy Duty Truck Streamline Virtual Service \| Motorcycle Custom/Classic (Non-Database) Streamline Virtual Service \| Motorcycles Streamline Virtual Service \| Other or Unknown Vehicle or Property Streamline Virtual Service \| Personal Property (Bicycles, Wheelchairs) Streamline Virtual Service \| Recreational Vehicles (RV, Travel Trailer, Camper) Streamline Virtual Service \| Residential Property Supplement Assist with Reinspection \| ATV/Golf Cart/Snowmobile Supplement Assist with Reinspection \| Auto/Light Truck (Classic/Exotic/Complex Database/Non-database) Supplement Assist with Reinspection \| Auto/Light Truck Premium (Database) Supplement Assist with Reinspection \| Auto/Light Truck Standard (Private Passenger) Supplement Assist with Reinspection \| Boat/Watercraft Supplement Assist with Reinspection \| Heavy Duty Trailer Supplement Assist with Reinspection \| Heavy Duty Truck Supplement Assist with Reinspection \| Heavy Equipment – Off-Road Construction Vehicles or Equipment Supplement Assist with Reinspection \| Heavy Equipment – Off-Road Farm/Forestry Vehicles or Equipment Supplement Assist with Reinspection \| Light Duty Trailer Supplement Assist with Reinspection \| Medium Duty Truck Supplement Assist with Reinspection \| Motorcycle Custom/Classic (Non-Database) Supplement Assist with Reinspection \| Motorcycle Stock (Database) Supplement Assist with Reinspection \| Other or Unknown Vehicle or Property Supplement Assist with Reinspection \| Personal Property (Bicycles, Wheelchairs) Supplement Assist with Reinspection \| Recreational Vehicles (RV, Travel Trailer, Camper)

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2	5	6	7	8	9	10	11
3	12	13	14	15	16	17	18
4	19	20	21	22	23	24	25
5	26	27	28	29	30	31	1
6	2	3	4	5	6	7	8