New Auto Claim Submittal

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RAC Adjustments, Inc. | New AUTO Claim Assignment

Company Name (Required)*

Email address*

Company Adjuster (Required)*

Direct Telephone Number (Required)*

Date of Loss (Required)*

Claim Number (Required)*

Cause of Loss (Required)*

Policy Holder's Name (Required)*

First Name

Middle Initial

Last Name

Suffix

Contact's Direct Telephone Number*

Policy Holder's Address

Policy Holder's City

Policy Holder's State

Policy Holder's Zip Code

Claimant Name (If Applicable) *

First Name

Middle Initial

Last Name

Suffix

Claimant's Direct Telephone Number

Claimant's Address

Claimant's City

Claimant's State

Claimant's Zip Code

Vehicle Year (Required)*

VIN Number*

Vehicle Make (Required)*

Vehicle Model (Required)*

Vehicle Location*

Vehicle City*

Vehicle State*

Vehicle Zip Code *

Deductible Amount

Area of Damage

Facts of Loss

Please leave notes for the adjuster. Thank you.

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Please upload your 4th file here.

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Find An RAC Adjustments, Inc. Adjuster

New Auto Claim Submittal

get in touch with rac adjustments, inc.

RAC Adjustments, Inc. | New AUTO Claim Assignment

Find An RAC Adjustments, Inc. Adjuster

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