LEGENDS
CLAIMS SERVICE of ARIZONA

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NEW CLAIM ASSIGNMENT
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Reporting Intervals *

7 Days

10 Days

14 Days

30 Days

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Investigation Request: *

Full Investigation

Task - Insured Statement

Task - Claimant Statement

Task - Witness Statement

Task - Scene Investigation

Task - Auto Appraisal

Task - Locate Witness

Named Insured *

Client [your contact info] *

Contact Information for Insured/Claimant/Witness *

Facts of the Loss /Comments / Other Instructions

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NEW CLAIM ASSIGNMENT

Full Investigations or Task Assignments
Input data below and attach documents or FAX Assignment to (480) 854-8917
24-hour contact to all parties
Status reports at your intervals
Detailed Investigations; Concise Reports
Acknowledgement of every new assignment

Claim Number *

Loss Date *

Thank you for this new assignment. We will proceed per your instructions. Our first report will follow within 15 days or sooner.

24-hour Adjuster Availability

(480) 854-8851 office

(480) 854-8917 fax

Claims@AZAdjuster.com