USAA Quote

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Adjuster*(Required)

Phone*(Required)

Email*(Required)

Employee ID*(Required)

Job Title*(Required)

Office*(Required)

unit

Litigation Unit

Non-Litigation Unit

Four Unit Code*(Required)

Line of Business

Liability

UIM

UM/UIM

Member Number*(Required)

Member Name*(Required)

Underwriting Company

Loss Report Number*(Required)

Date of Loss (mm/dd/yyyy)*(Required)

Location of Loss*(Required)

Injury*(Required)

Claimant*(Required)

Claimant's Birth Date (mm/dd/yyyy)

Claimants Gender

Male

Female

Names of Parent(s)/Natural Guardian(s), if applicable.

Dependents

Total Offer

Annuity Amount

Defense Attorney

Defense Attorney Phone

Defense Attorney Email

Defense Attorney Fax

Plaintiff Attorney

Plaintiff Attorney Phone

Plaintiff Attorney Email

Plaintiff Attorney Fax

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