Date of Report Submission: 10/23/25
Name:
Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Repair Facility: My Repair Facility
State Appraiser License: 23423
Shop Representative: Bob Schwab
Address: 3454 Main Street
City: Audubon
State: Pennsylvania
Zip: 19403
Phone:
Insurance Company: My Insurance Co
Claim Number: 57484
Insurance Company Representative: Mary Smith
Date of Loss: 09/17/2025
Appraiser License Number: 657484
Insurance Company Phone: 555-555-5555
Consumer Legislative Representative: N/A
Consumer Senator: N/A
Repair Facility Legislative Representative: N/A
Repair Facility Senator: N/A
Complaint Comments:
This is a test of the complaint library. Please let me know if you received this complaint. Thank you! Jill Sardella The Marketing Department