Make an Assignment

Home
About
Make an Assignment
Resources
Contact

Menu

Home
About
Make an Assignment
Resources
Contact

Clients can now use our online forms to submit new claim assignments via the Internet. Your assignment will be received by our office and handled according to your instructions. Online assignments are acknowledged per your instructions.

Fill out the form below to submit an online assignment now. If you need further assistance, please contact us.

Type of Property Involved

Date of Loss

Claim Number

Policy Number

Cat Code

Description of Loss

General Assignment Instructions

First Name

Last Name

Client Company Name

Mailing Address

Building/ Suite

City

State

Zipcode

First Name

Middle Name

Last Name

Phone Number

Other Phone Number

Fax

Instructions/ Other Information Regarding Insured

Coverage A

Coverage B

Coverage C

Coverage D

Other

Agent First Name

Middle Name

Last Name

Agency/ Broker Company Name

Address 1

Address 2

City

State

Zipcode

Phone Number

Other Phone Number

Fax

Instructions/ Other Information Regarding Insured

Additional party is

Claimant Witness Other

Agent First Name

Middle Name

Last Name

Company

Address 1

Address 2

City

State

Zipcode

Phone Number

Fax

Instructions/ Other Information Regarding Insured

Confirm Assignment Receipt

Email Phone 1st Report

Report Within

1-3 Days 3-7 Days 7-15 Days 15-30 Days

Make an Assignment

Claims

Contact