Corey Hopkins Appraisals
7 Day St.   Fredericton N.B.
Ph 506-455-2214  Fax 506-474-1718
              Cell  506-447-2190
APPRAISAL REQUEST FORM
POLICY#:

CLAIM#:

OWNER NAME, ADDRESS & PHONE#:

INSURED NAME:

VEHICLE YEAR MAKE & MODEL:

VIN & LICENCE#:

TYPE OF LOSS:

DATE OF LOSS:

DEDUCTIBLE:

LOCATION OF DAMAGE:

LOCATION OF VEHICLE / SHOP:

INSURANCE CO / ADJUSTING FIRM:

ADJUSTER NAME PHONE & FAX#:

ADJUSTER E-MAIL ADDRESS:

Please add any information below, include policy endorsements, without prejudice, etc:


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Note: You will receive appraisal via e-mail in Adobe PDF form