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Claim Information * Required Field

@if (session()->has('message'))

@endif

Assignment Priority

Standard

Same Day

Next Day

Insurance Company * @error('form_data.insurance_company_id')

@enderror

Adjuster @error('form_data.adjuster_id')

@enderror

Claim Number * @error('form_data.claim_number')

@enderror

Policy Number @error('form_data.policy_number')

@enderror

Deductible amount @error('form_data.deductible_amount')

@enderror

Catastrophe

Claim For @error('form_data.claimfor')

@enderror

Date of Loss @error('form_data.date_of_loss')

@enderror

Type of Loss

@if ($comprehensive_fields == true)

Sub Type

@endif

Service Requested

Unit Type

Insured Name @error('form_data.insured_name')

@enderror

Type of Loss Description

Collision - This is dealing with an automobile.

Commercial Property - This is real property - real estate.

Comprehensive - This is dealing with an automobile.

Liability/PD - This is dealing with an automobile.

Other - This is dealing with an automobile.

Residential Property - This is real property - real estate.

Owner Information

Business Name @error('form_data.business_name')

@enderror

Owner First Name @error('form_data.business_first_name')

@enderror

Owner Last Name @error('form_data.business_last_name')

@enderror

Email Address @error('form_data.business_email_address')

@enderror

Phone Number (Cell) @error('form_data.business_phone_number')

@enderror

Phone Number (Home) @error('form_data.additional_phone_number')

@enderror

Phone Number (Work) @error('form_data.phone_number_work')

@enderror

Contact Name @error('form_data.business_contact_name')

@enderror

Address @error('form_data.business_street')

@enderror

City @error('form_data.business_city')

@enderror

State

Postcode @error('form_data.business_postcode')

@enderror

@if ($residential_property_fields == true) Property Location @else Vehicle Location @endif

@if ($residential_property_fields == false)

View facility Vehicle Location

@if (session()->has('facilities_modal_message'))

@endif

Location Name @error('form_data.vehicle_location_name')

@enderror

Location Phone @error('form_data.vehicle_phone_number')

@enderror

Additional Shop Information
Yes No

@endif

Address @error('form_data.vehicle_street')

@enderror

City @error('form_data.vehicle_city')

@enderror

State

Postcode @error('form_data.vehicle_postcode')

@enderror

@if ($additional_shop_info_selected === "YES")

Shop business details

From

Lunch From

Lunch To

Shop License

Shop Tax ID

Location Fax

Shop Contact Name

Shop Email

Shop Phone

@endif @if ($residential_property_fields == false)

Vehicle Information

VIN @error('vehicle_info.vehicle_vin')

@enderror @if (session()->has('vin_decoded')) {{ session()->get('vin_decoded') }} @endif

Decode

Year @error('vehicle_info.vehicle_year')

@enderror

Make @error('vehicle_info.vehicle_make')

@enderror

Model @error('vehicle_info.vehicle_model')

@enderror

License Plate @error('vehicle_info.vehicle_license_plate')

@enderror

Color @error('vehicle_info.vehicle_color')

@enderror

Mileage @error('vehicle_info.vehicle_mileage')

@enderror

Vehicle Damage @error('vehicle_info.vehicle_note')

@enderror

@endif @if ($residential_property_fields == true)

Property Damage

Damage

@endif

Inspection Appointment

Appt Date/Time @error('form_data.appointment_date')

@enderror

Instructions @error('form_data.instruction')

@enderror

Attachment Files @error('form_data.newfileattach.*')

@enderror @if ($form_data['newfileattach'])

@foreach ($form_data['newfileattach'] as $index => $file)

{{ $file->getClientOriginalName() }} ({{ number_format($file->getSize() / 1024, 2) }} KB)

@endforeach

@endif

Add New Assignment

Claim Information * Required Field

Type of Loss Description

Owner Information

@if ($residential_property_fields == true) Property Location @else Vehicle Location @endif Same As Above

Shop business details

Vehicle Information

Property Damage

Inspection Appointment

Priority Assignment Details

Facilities

Facility Contact

@if ($residential_property_fields == true) Property Location @else Vehicle Location @endif