Assign a project | EFI Global

Assign a project – United States

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Client Contact Information

Company Name

Company Division

Name (First Last)

Country

Phone

Email(Required)

Summary of Loss

Please provide the scope of work for this loss.

Service/Inspection requested

Vehicle VIN, make, model

Loss location

Claim number (if applicable)

Loss date (if applicable)

Loss Address

Loss Address 2

Loss City

Loss State / Province / Region(Required)

Loss Zip / Postal Code

Loss Country(Required)

Assessment Location (If applicable)

If the assessment/inspection location is different from the loss location, please provide the address

Assessment Address

Assessment Address 2

Assessment City

Assessment State / Province / Region

Assessment Zip / Postal Code

Assessment Country

Insured's Contact Information

Insured's Name

First Last

Site Contact Name

Site Contact Phone Number

Attachments – Please include any related documents.

Max. file size: 256 MB.

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Assign a project – United States

24 Hour Response (USA): 888-888-2467

Client Contact Information

Summary of Loss

Loss location

Assessment Location (If applicable)

Insured's Contact Information

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