Dummy Contact Page Company Name Date Main Contact Phone Number Email Address Branches TypeChoose an item.CarrierTPAMGAFinancialOther AdjustersChoose an item.Adjuster ListSingle AdjusterSingle Adjuster per Branch Adjusters Attach How will assignments be sent to IAnet?Choose an item.Audatex Claims ManagerCCCEmailEntegralFaxIAnet PortalMitchell Work CenterNUGEN ITOther If other was selected, fill in information here: How will completed reports be returned to the client?Choose an item.Audatex Claims ManagerCCCEmailEntegralFaxIAnet PortalMitchell Work CenterNUGEN ITOther If other was selected, fill in information here: File bundling requirements? Choose an item.No bundlingBundle all togetherSeparate out estimateSeparate out invoice Does the estimate get released? Choose an item.Yes - Owner / ShopYes - OwnerYes - ShopNoSupplements Only Mileage Approval Contact? Will the carrier need our insurance certificate? Choose an item.yesNo Send Certificate To: Email User Access Credentials To IAnet Portal & Services (Please List All Users) Name Email Address Phone Attachment Complete Total Loss report when repair cost equals or exceeds:Choose an item.65%70%75%80%OtherDiscuss With Account Manager If other was selected, fill in information here: Total Loss Valuation SourceChoose an item.ADP AutosourceADP Autosource and DCIAverage of Dealer Quotes and BookCCCDCITotal Loss Valuation Source: Dealer QuotesNADANADA/Blue Book/Red Book-Average 2VVSDiscuss With Account Manager If other was selected, fill in information here Total Loss Valuation Options (check box): No total loss handlingFill out form onlyObtain valuation using IAnet office ID# (Audatex, DCI, or VVS Only)Obtain valuation using company’s office ID# Type in ID# (Applies to All Sources)Discuss With Account ManagerOther Do you have a guidelines manual? Choose an item.yesNo Guidelines for LKQ part usage Choose an item.12 Months or 12,000 Miles24 Months or 24,000 MilesDo not useOtherDiscuss With Account Manager Guidelines Attach If other was selected, fill in information here Parts Excluded Guidelines for Aftermarket part usage: Choose an item.12 Months or 12,000 Miles (CAPA Certified sheet metal)24 Months or 24,000 Miles (CAPA Certified sheet metal)Do not useOtherDiscuss With Accout Manager If other was selected, fill in information here: Parts Excluded Betterment/Depreciation: Please list if company has specific instructions or attach Depreciation Schedule on separate page. If not, IAnet abides by state regulations and industry standards. **This information should be placed on a separate page or in the notes section** Billing Contact Phone Number Email Address Invoicing Details Choose an item.Bulk billing - watermarked invoice sentBulk billing - no invoice sentInvoice to AdjusterInvoice to Specific Email Address Invoice Email Address MA / CA DOI Reporting YesNo Massachusetts & California DOI Reporting: (DOI reports are ran quarterly unless the carrier wants something different) Does the client need a Massachusetts & California DOI report emailed to them? Choose an item.YesNo At what frequency? Choose an item.MonthlyQuarterly Will you need IAnet to reopen completed files to complete a DOI reinspection? Choose an item.YesNo Massachusetts &CA DOI Contact: Phone Number Email Salvage pool or contract buyer YesNo Company Name Contact Person ID# Phone Fax: Email ** If there are multiple yards, please list them on a separate sheet** Additional Notes
