Submit an Assignment Please enter your assignment information below. Fields marked with (*) are required. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Adjuster Name *FirstLastInsurance Company *SelectAmica MutualAuto OwnersCincinnati InsuranceErie InsuranceFarm BureauFarmers MutualFCCI Insurance GroupFidelity InspectionsHanover Insurance GroupLiberty MutualNationwide InsurancePure InsuranceShelter InsuranceState FarmThe HartfordTravelers InsuranceOtherInsurance Company - OtherAdjuster Phone *Adjuster Email *Assignment DetailsInsured or Entity Name *Primary Contact *FirstLastPrimary Contact Phone *Primary Contact EmailLocation of Assignment *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeClaim Number *Date of LossAssignment Type: *AppraisalComplex Commercial LossComplex Residential LossMitigation ReviewMulti-Building Roof InspectionResidential Roof InspectionOtherAssignment Type - OtherLoss Details: *Supporting Documentation Upload Click or drag files to this area to upload. You can upload up to 5 files. Files can be no larger than 5mb each. For larger files, use the box below. Acceptable formats are .pdf, .png, .jpg, .esx, .doc, .docx, .xls, and .xlsxClick to upload file larger than 5mbClick to upload file larger than 5mbUpload file up to 64mb Click or drag a file to this area to upload. If your files exceed the form limits, click here, and we will provide alternative submission methods.If your files exceed the form limits, click here and we will email you with an alternative submission method.Submit
