Adjuster Info Hotline
(865) 321-9441
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Contact Information Confirmation
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Indicates required field
Name
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First
Last
Email
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Phone Number
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1. Are you currently willing to work claims as an independent adjuster?
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Yes
No
2. Are you available to work claims...
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Business hours ( 8am-5pm)
After business hours and on weekends
All the above
I am not available and no longer adjusting claims
3. What states do you currently hold an adjuster license for (select all that apply - we understand not all states license adjusters):
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Colorado
District of Columbia
Alabama
Alaska
Arizona
Arkansas
California
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Indiana
Kentucky
Louisiana
Maine
Massachusetts
Michigan
Minnesota
Mississippi
Montana
Nevada
New Mexico
North Carolina
Oklahoma
Rhode Island
South Carolina
Texas
Utah
Vermont
Washington
Wyoming
None
Please list any other licenses or certifications:
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5. What is your current home address
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6. Are you in an area away from your home, but plan to return in less than 6 months?
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Yes
No
If yes, please explain:
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7. Please list any additional contact phone number
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8. Please list your emergency contact information including: contact name, phone number, and their relationship to you:
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