I.A.S. Registration:
Please fill out the form as complete as you can and then hit the SUBMIT button at the very bottom of this screen. Once you have submitted the form you should receive a confiration email from us. If you do not receive an email please repeat this form. Thank you.
Let's begin with....

First Name:   Last Name:     Middle Name or Initial: 

Street Address:  
                City:    State:      Zip: - Country:   
             Email: 
             Phone - is this your cell? Y  N       Another Phone #?
SSN:              
Date of Birth:  


ARE YOU INTERESTED IN WORKING:
   DAILY CLAIMS?Y  N     
   CATASTROPHE CLAIMS?Y  N   

 

 

ARE YOU SKILLED IN PROPERTY? Y  N  

If yes, please fill in the blue area questions. If no, please proceed to question 6 - AUTO.
if YES for PROPERTY:  HOMEOWNERS?Y  N       
   COMMERCIAL?  Y  N   
 
1. NUMBER OF YEARS FOR EACH SKILL LISTED BELOW:
 
      a. WIND   
      b. HURRICANES    
   which hurricanes?      
      c. HAIL    
      d. EARTHQUAKE    
      e. FIRE    
      f. FARM    
      g. INSIDE EXAMINER   
      h. UPP (Unscheduled Personal Property)    
      i. GENERAL ADJUSTER    
      j. FLOOD    
      k. FIELD SUPERVISOR   
 
2. ADJUSTING COMPANIES:
 
      LIST THE COMPANIES YOU HAVE PREVIOUSLY DEPLOYED FOR
  
 
3. ESTIMATING SYSTEMS:Which of the following have you used?
 
      XACTIMATE Y  N   
      XactAnalysis Y  N   
      INTEGRA Y  N   
      MSB CommCentral Y  N   
      POWERCLAIM Y  N   
      SIMSOL? Y  N   
      ...and other estimating systems used?    
 
4. ARE YOU INTERESTED IN WORKING:
 
      OUTSIDE Y  N   
      INSIDE DESK EXAMINER Y  N   
      FIELD SUPERVISOR OVERSEEING A TEAM OF ADJUSTERS? Y  N   
      UPP (UNSCHEDULED PERSONAL PROPERTY)? Y  N   
      MEDIATIONS? Y  N   
      GENERAL ADJUSTER (LARGE LOSS)? Y  N   
 
5. DO YOU HAVE ANY CERTIFICATIONS SUCH AS:
 
      NFIP Y  N   
      TEXAS WIND POOL Y  N   
      CALIFORNIA EARTHQUAKE CERTIFICATION? Y  N   
      ...any other Property certifications?     

 

 

 

 

 

 

 

 

 

 

 




6. DO YOU HAVE AUTOMOBILE ESTIMATING EXPERIENCE: Y  
    if YES for AUTOMOBILE How many years experience in Auto?
 
WHICH ESTIMATING SYSTEMS DO YOU HAVE EXPERIENCE WITH
 
      CCC PATHWAYSY  N   
      MITCHELLY  N   
      AudatexY  N   
      ...any other estimating systems used?
    
 What companies have you deployed for and for how many years?

 

 

 

 

 

 

 


7. DO YOU HAVE CASUALTY ADJUSTING EXPERIENCE:  Y  
    if YES for CASUALTY How many years experience in Casualty?
    What companies have you deployed for and for how many years?

 

 

 


       In What STATES DO YOU HAVE AN ADJUSTER LICENSE?  (include license #s when known)               

Has licenses in all states.                                             

   Alabama            Maine                  Pennsylvania   
   Alaska               Maryland             Rhode Island 
  Arizona               Massachusetts      South Carolina   
   Arkansas            Michigan              South Dakota
   California            Minnesota            Tennessee
   Colorado            Mississippi           Texas            
   Connecticut         Missouri              Utah        
   Delaware            Montana             Vermont       
   D.C.                   Nebraska             Virginia       
   Florida                Nevada                Washington    
   Georgia               New Hampshire   West Virginia
   Hawaii                New Jersey         Wisconsin
   Idaho                  New Mexico        Wyoming 
   Illinois                 New York
   Indiana               North Carolina   
   Iowa                  North Dakota  
   Kansas              Ohio
   Kentucky           Oklahoma
   Louisiana          Oregon 
 




 

Thank you for taking the time to provide us with your information.  We look forward to
working with you during this upcoming storm season.  If you have any questions about
I.A.S., please visit our website at www.iasclaims.com,

or e-mail Don Stephens at dstephens@iasclaims.com.

 

Now please hit the SUBMIT button to save your registration. You can then close the resulting screen. Thank you..