Please utilize the form below to submit an assignment online.

Alternately, you can download the new matter submission form HERE.

You can also email or call us at 866-899-8756 option 1 to submit a new assignment.

PLEASE NOTE: This form is not compatible with Internet Explorer or some versions of Microsoft Edge, please use an alternate browser (Chrome preferred) or contact us for other ways to submit your claim assignment. 

    Client/Adjuster Details

    First Name*

    Last Name*


    Phone Number*

    Claim Details

    Claim #

    Named Insured

    Insured Contact Name

    Insured Contact Business Phone

    Insured Contact Mobile Phone

    Insured Contact Home Phone

    Insured Contact Email

    Date of Loss

    Loss Location

    Assignment Tasking

    Additional Claim/Assignment Notes

    Do you have claim documentation or photos?

    NoYes, I'll email them to