Assign a Claim - Complete Claims Service

Assign a New Claim

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Claim Number

Date of Loss

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Adjuster Name

Adjuster Phone

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Adjuster Email

Insurance Company

Insured's Name

First

Last

Claimant's Name

First

Last

Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Inspection Location

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Vehicle Year

Vehicle Make

Vehicle Model

Vehicle Color

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Vehicle Identification Number (VIN)

Vehicle License Plate #

Any Special Instructions

File Upload

Click or drag a file to this area to upload.

Checkboxes