Assign a New Claim
 

When Assigning New Claim please provide the as much of the following information as possible or attach your own loss form. 

CLIENT

  • Company Name

  • Client Rep

  • Client Phone 

  • Client Email

CLAIM

  • Claim Number

  • Policy Number

  • Deductible

  • Date of Loss

Insured/Claimant

  • Name

  • Address

  • Phone

  • Cell

  • Email

Vehicle Details

  • VIN

  • Year

  • Make

  • Model

  • Color

  • Plate Number

Location

  • Complete address

  • Special instructions

Vehicle Damage

  • Impact Area

  • Drivable Y/N

  • Notes