admin login:    

Submit an Assignment

 
Submit an Assignment
* Office Code:
* Assignment Type:
* Year:
* Client Company
* Client Name
Client Address
Client City
Client State
Client Zip
* Client Phone
* Client Email
* Client Claim Number:
Policy Number:
* Date Of Loss:
Insured Address
* Insured Last Name
Or Business Name:
Insured First Name:
Address 1:
Address 2:
City:
State:
Zip:
Work Phone:
* Home Phone:
Mobile Phone:
Email Address:
Claimant Address
Claimant Last Name:
Claimant First Name:
Address 1:
Address 2:
City:
State:
Zip:
Work Phone:
Home Phone:
Mobile Phone:
Email Address:
Loss Location:
Same As Insured Address:
Address 1:
Address 2:
City:
Description of Loss:
Upload File
Urgency
 

If you need to submit an assignment, make sure you have your claims information handy, and click here »

Looking for a branch location near you? Just enter your zip code below.

Zip Code:  

Visit the Client Portal to view assignment status and to submit new assignments.