New Property Claim Assignment Submit a Claim Contact informationName(Required) Company Name(Required) Address City State ZIP Code Phone(Required)Email(Required) Claim InformationHandling Procedure(Required) RUSH ASSIGNMENT Immediate Response Requested Full Adjustment Damage Appraisal Appraisal Investigation Other Please Specify(Required) Date of Loss MM slash DD slash YYYY Type of Loss Insured InformationInsured Name(Required) Insured Contact Insured Address City State ZIP Code Insured PhoneInsured Alt. PhoneInsured Email Claimant InformationClaimant Name Claimant Contact Claimant Address City State ZIP Code Claimant PhoneClaimant Alt PhoneClaimant Email Loss informationLocation of Loss Insured Address Claimant Address Other Please specify Loss Address City State ZIP Code Loss Description(Required)Handling/ Additional Instructions Upload Loss Notice &/or Additional DocumentsAccepted file types: pdf, png, jpg, docx, Max. file size: 100 MB.NameThis field is for validation purposes and should be left unchanged.
