For Insurance Co’s Adjuster Submitting Job Assignment:*-- Choose One --Desk AdjusterField AdjusterADJUSTER ASSIGNING CLAIMAdjuster First Name*Adjuster Last Name*Email* Adjuster Cell / Extension*DESK ADJUSTER INFORMATIONDesk Adjuster First Name*Desk Adjuster Last Name*Desk Adjuster Email* Desk Adjuster Cell / Extension*CAPTCHACARRIER INFORMATION TO INVOICECarrier Company*Carrier Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CLAIMANT INFORMATIONClaimant First Name*Claimant Last Name*Loss Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Claim Number*Primary Phone*Secondary PhonePUBLIC ADJUSTERPublic Adjuster NamePublic Adjuster Primary PhonePublic Adjuster Secondary PhoneTYPE OF DETECTION NEEDEDType - Choose all that apply:* Cause & Origin Drain Camera Inspection Drain Smoke Test Drain Hydro Jetting (to be reviewed per request) Slab Leak Irrigation Pool Other (Describe in comments section) Brief Description of problem:*Add AttachmentAccepted file types: jpg, gif, pdf, png, Max. file size: 5 MB.Submission Agreement* Submission of this form indicates an agreement between Sleuth Inc. and the Insurance Carrier to issue payment directly to Sleuth Inc.