Engineering Work Order

Insurance Claim Investigation

To begin the scheduling process, please FAX this completed form to 828-726-1664.

Insured	Insurance Company
	Contact person
Address to be inspected	Current mailing address
Home telephone number Work telephone number	Telephone number
Claim Number:	FAX number:
Problem:

Please fax this form to our office at 828-726-1664 and we will contact you within one business day to schedule the inspection.

The typical cost of a site visit and report describing one to three damages is $750.00 to $2,000.00. Conditions that are more complex may cost more. There will be no additional charges for travel within our normal operating area, which includes Asheville, Boone, Hickory and Statesville.

This form is for informational purposes intended only to expedite scheduling of the claim investigation and does not replace a signed contract. This form is not an agreement nor guarantee of services or price listed within.

OFFICE USE ONLY

SCHEDULED DATE: ____________________________________ TIME: ________________________________

JOB NUMBER: ___________________________________ OFFICE DEADLINE ____________________________

Has contract been signed Y / N