Insurance Company Assignment Form (insurance companies only)

CCA Vehicle Appraisal Assignment Form

Please fill in the Assignment Form information below. (All fields marked with an Asterisk * are required).

Please Select Service From Dropdown List Below*
Assignment Instructions
Inspect vehicle – Obtain photos of vehicle to document condition. Document options and mileage (if available). Establish Pre-loss Actual Cash Value of vehicle.
Assignment Instructions
Review repair documentation and photos. Complete appraisal report indicating any loss in value due to the damage, repairs and history.
Assignment Instructions
Obtain at least 4 corner Photos of vehicle – Check areas of repaired damage and document any obvious signs of repair including but not limited to: paint color mismatch, trash in paint, orange peel, fish eyes and tape marks, look for unusual gaps in sheet metal. Note any other signs of incorrect or improper repair. Provide opinion of the overall quality of the completed repair as well as note any deficiencies.
Administrative Info
Company Name*
Company ID (if known)
Street Address*
City*
State*
Zip Code*
Adjuster/Contact*
Phone*
Extension
Fax*
Email*
Claim Info
Date of Loss*
MM slash DD slash YYYY
Claim #*
Policy Number (if needed)
Loss Type*
Vehicle Owner Information
Insured or Claimant Vehicle*
Owners Name*
Home Phone*
Cell Phone*
Work Phone
Street Address*
City*
State*
Zip Code*
Vehicle Description
VIN Number*
Mileage at Date of Loss*
Year of Vehicle*
Make*
Model*
Series/Trim*
Color*
Doors*
Transmission*
Prior Damage History?*
If Yes, Date of Prior Damage
MM slash DD slash YYYY
Cost of Prior Repairs
Describe The Damage History
Upload Documentation and Photos
Upload Final Repair Documentation
Accepted file types: jpg, gif, doc, docx, tif, png, pdf, Max. file size: 256 MB.
Upload Photos (if any)
Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.
Submit Your Form

Insurance Company Assignment Form (insurance companies only)

CCA Vehicle Appraisal Assignment Form

Assignment Instructions

Assignment Instructions

Assignment Instructions

Administrative Info

Claim Info

Vehicle Owner Information

Vehicle Description

Upload Documentation and Photos

Submit Your Form

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