Assignment Request – AAA Roof Technologies Inc 866-561-5374

Request date

Adjuster Name

Adjuster Phone Number

Adjuster Email

Insurance Company

Type of Inspection

Claim Number

Insured First Name

Insured Last Name

2nd Insured First Name

2nd Insured Last Name

Contact Person (Other than Insured)

Someone who may be handling the claim.

Insured Address

Address Line 1

Address Line 2

City

State

Zip Code

Do you have a roof diagram

If you have a roof diagram, click yes and upload it with this assignment request or send the roof diagram to claims@aaarooftechnologies.com

Permission To Text Insured

Insured Phone #1

Insured Phone #2

Insured Email

First Adjuster have

Roofer / Public Adjuster

RC / PA Phone

Notes

File Upload

Drag & Drop Files, Choose Files to Upload