Associated Adjusting Roster Application

-Please complete the following information to be added to the Associated Adjusting roster.

If you have any questions, please contact Ginger Johnston, Roster Manager at 866-833-4036 or by email at ginger.johnston@associatedadjusting.com

Once completed, you will receive a follow-up email with additional information and further instructions to complete the onboarding process.

Thank you for your interest in working with Associated Adjusting.

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* 1. Contact Information

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* 2. Driver's License:

State:

Driver's License Number:

Expiration Date:

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* 3. Next to the states in which you hold an active adjuster license, please enter the License Number and Expiration Date.

Alabama

Alaska

Arizona

Arkansas

California

Connecticut

Delaware

Florida

Georgia

Hawaii

Idaho

Indiana

Kentucky

Louisiana

Maine

Massachusetts

Michigan

Minnesota

Mississippi

Montana

Nevada

New Hampshire

New Mexico

New York

North Carolina

Oklahoma

Oregon

Rhode Island

South Carolina

Texas

Utah

Vermont

Washington

West Virginia

Wyoming

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* 4. Adjusting Interest: Mark all that apply.

Field Assignments

Desk/Remote Adjusting

CAT/Deployments

Associated Adjusting Roster Application

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* 1. Contact Information

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* 2. Driver's License:

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* 3. Next to the states in which you hold an active adjuster license, please enter the License Number and Expiration Date.

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* 4. Adjusting Interest: Mark all that apply.

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* 5. If applicable, please give the name of the adjuster school you attended.

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* 6. Were you referred to us by someone? If yes, please include name in box provided.

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* 7. If there is additional information or comment that you would like to include, please type here.