Assign a Claim Your Name First Last Company NameAlton RoofingFlorida Coastal ConstructionIA Public Insurance AdjusterOther-Please Fill in BelowOther CompanyDate Date Format: MM slash DD slash YYYY Email PhoneYour relationship to the claim?InsuredContractorAttorneyPublic AdjusterOtherWhat type of assignment?Public AdjustingAppraisalLitigated SupportMediation/Loss ConsultingDuplicateSupplementOtherUpload Files or Documents Here Drop files here or Insured Name First Last Address of Damaged Property Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Insurance CompanyPolicy NumberStatus of ClaimDeniedLoss Below DeductibleNewSupplementOtherRequest InternalInitial Client MeetingInitial InspectionCarrier InspectionEngineering InspectionEstimateSupplementDuplicateTeam LeadMediationAppraisalOtherSpecific Requests
