Send us your assignment by simply filling out this online form. If you prefer faxing, please use this printable assignment form and fax it to 206-363-8183. Your Email:     (* Required) Insurance Company  Adjuster's Name  Address  Phone  Fax:  Claim  Date Assigned  Date of Loss Insured  Address  Home Phone  Work Phone  Claimant  Address  Home Phone  Work Phone  Vehicle  Year Make  Model  License  Color  VIN  Location Shop Choice  Shop Phone  Estimate $  Coverage Coll PD  Comp  Damage/ Special Instructions

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