Assign a ClaimAssign a ClaimWhat State is Loss Located?(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDate of LossAddress of Loss(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Insured Name(Required) First Last Additional Insured Name First Last Insured Email(Required) Insured Phone(Required)Name of Person Completing Form First Last Your Company NameYour PhoneYour Email Contractor InformationCompany NameContractor PhoneContractor Email Type of Loss(Required)CommercialResidentialBrief Description of the loss/damage(Required)What type of assignment?Public AdjustingAppraisalLitigated SupportMediation /Loss ConsultingDuplicateSupplementOtherIf Supplement Dollar Amount Paid/NotesPlease Choose OneFireWindHailMediation /Loss ConsultingWind/HailHurricaneWater DamageFloodPipe Break/LeakVandalismOtherInsurance Company(Required)Policy Number(Required)Status of Claim(Required)DeniedNewSupplementOtherClaim NumberUpload Documents Here Drop files here or Select filesMax. file size: 256 MB. Request InternalInitial Client MeetingInitial InspectionSupplementCarrier InspectionEngineering InspectionEstimateSupplementLitigated SupportDuplicateTeam LeadMediationAppraisalOther