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, please use an alternate browser or contact us for other ways to submit your claim. 

    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