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Adjuster Roster

Info

First Name

Last Name

Email Address

Phone Number

Street Address

Address 2

City

State

Zip Code

Would you like to receive text messages? Yes or No YesNo

Daily Assignments? Yes or No YesNo

Available for Deployment? Yes or No YesNo

Storm Assignments? Yes or No YesNo

State Licenses, Designations & Certifications

Adjuster State License

License Number

National Producer Number (NPN)

Non-Resident Licenses

E&O Yes or No YesNo

Carrier

Policy Number

Designations

FCN

FCN Upload

CFGA Yes or No YesNo

CGA Yes or No YesNo

Other Certifications

Xactimate Address

Xactimate Certifications 1, 2 or 3 123

Upload Certification

Simsol Yes or No YesNo

Symbility Address

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