Heinrich and Company

Please fill out this form if you have a new appraisal assignment regarding vehicles, heavy equipment, farm equipment,
R.V.'s, or boats.

From(required):	Insurance Company Self-Insured
Report To:
Email Address (required):
Phone Number (required):
Fax:
Agent:
Phone:
Claim #:
Policy #:
Deductible:
Date of Loss:

INSURED

CLAIMANT

Type of vehicle to be appraised:
private vehicle
pickup truck
boat
rv
other

Vehicle is owned by:
insured
claimant
other

Location of unit to be appraised:

Driveable:yesnon/a

If applicable, owner's preference of repair facility, if known:

Copy of damage appraisal to shop:yesno

Copy of damage appraisal to owner:yesno

If vehicle is total loss write appraisal to show total:yesno

If vehicle is total loss:
Do total loss worksheet?
  yes
  no
Solicit salvage bids?
  yes
  no

Additional instructions/remarks:

Please send to: