Business/ Individual Name:		Submitted By:
Email:		Fax:
Date:

Particulars:
Claimant:		Estimator:
File #:		Estimate Date:
Adjuster:

Pertains To:

Accreditation	Previous Damage	Personalities
Education	Procedures	Communication
Environment	Recycled Parts	Estimating Time
Business Acumen	Inspections	Company Staff
Equipment	Coverage	Suppliers
Client	Report Costs	Materials
Deductibles	Repair Authorizations	Insurance Personnel
		Other

In your estimation, is this an area claims centre problem or is it local in nature? (pertain to you only)
Please describe the situation as you understand it.
What would you want to see done about it, and how would you resolve this situation?
What can SAAR do to help you to eliminate this challenge in your life?