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.

Client/Adjuster Details

First Name (required)

Last Name (required)

Company (required)

Phone Number (required)

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