Assign a Claim Carrier InformationCarrierSelect a carrierAcuityAmerican International Group IncAllstate Ins GroupAmerica First InsuranceAmerican Capitol AssuranceAmerican Strategic InsuranceAmeriprise Auto and HomeAmerican Family Insurance GroupAmTrustAuto-Owners Ins GrpBankers InsuranceCATO CorporationCentury Fire ProtectionCentury21-Ron LaughlinCFM InsuranceChubb Mitigation AssignmentChubb Reconstruction AssignmentCitizens Prop Ins CpCode Blue TPAColorado Casualty InsuranceCornerstone National InsuranceCalif State Auto GrpCountry Financial InsuranceCypress InsuranceDagley Insurance AgencyEncompass InsuranceErie Ins GroupFarm Bureau Insurance of KentuckyFarmers Ins GroupFedNatFlorida Insurance Guaranty AssociationFlorida SpecialtyFiremans FundFirst Service BusinessGolden EagleHannahstown Mutual InsHartford Ins GroupHippo Insurance ServicesHomeOwners ChoiceHomesiteHomewise InsuranceIndiana InsuranceKettlerLiberty NorthwestLoggerhead InsuranceMetLife Auto and Home GrMontgomery Insurance CoMount Morris MutualNA Risk Ins CoNarragansett Bay Insurance CoNationwide Allied Insurance CoOhio Casualty GroupOlympus Insurance CompanyPDN Select Commercial AccountsPeerless InsurancePlymouth Rock InsuranceSafeco Ins CosService AmericaSouthern Trust InsuranceStar and ShieldState AutoState Farm GroupSwyfftTravelers Ins CoUniversal North AmericaUSAA GroupUtica National Insurance GroupVault InsuranceWest Bend Mutual InsuranceYellow-RoadwayOTHERReferral TypeReferral Type Restoration Mitigation Appraisal Comparative Estimate Insured/Resident InformationFirst Name Last Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEvening PhoneEmail Is Owner Information Different? Yes THIS IS AN ATTORNEY REPRESENT FILE. DO NOT CONTACT THE INSURED DIRECTLY.If this is an attorney represent file, please check "yes" to fill out some information about the point of contact. Yes Attorney Contact InfoFirst Name Last Name PhoneEmail Owner InformationFirst Name Last Name Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEvening PhoneEmail Policy InformationClaim Reference #: Policy Number: Deductible Amount: Policy LimitsDwelling Contents Other Loss InformationLoss Date MM slash DD slash YYYY Loss TypePick Loss TypeAnimal DamageAppraisal / Estimate OnlyAsbestosBreak and EnterConstructionContentsDisinfectionDocument DryingEarthquakeElectronicsEmergency Action Plan InspectionExplosionFireGeneral CleaningGrow OpHailHazardousHurricaneIce DamJanitorial - Non InsuranceLaundryLead AbatementLightningMeth LabMoldOdourOil SpillOtherProperty InspectionRemodelingRenovationRiotRoofSmokeStructural CollapseTemporary RepairsTornadoTrauma Scene (Body/Blood)Tree FallVandalismVehicle ImpactWater - Burst Pipe, Clean, Category 1Water - Sewer Backup, Black, Category 3Water - Sump Pump, Grey Water, Category 2Wind - Fencing/Exterior StructuresWind - Roof/SidingIs Emergency Yes Loss DescriptionAdjuster InformationFirst Name Last Name Independent Adjuster: E-mail address to send confirmation of assignment to: Assigned Franchise By clicking "Submit", you agree to our Terms of Use, which contain a mandatory arbitration provision.CAPTCHA Δ