Property Assignment Form

*Note: All fields marked with an asterisk (*) are required.

Adjuster Information

Adjuster NameInsurance CompanyMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressDOLClaim NumberPolicy NumberDeductible

Insured Information

First NameLast nameMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressDamage Description

Claimant Information

First NameLast NameMailing AddressBuilding/SuiteCityStateZipPhone NumberFax NumberEmail AddressDamage Description

Instructions

Other Special InstructionsDo you want us to reach an agreed price with the insured/claimant?
Do you want us to confirm the cause of your loss?
How do you prefer we return assignments to you?

 

Attachments

Attachment 1Attachment 2Attachment 3
 
Enter your email address below
*Contact Email
 
Intermountain Service Areas

Idaho Service Area
We provide WC and P&C services throughout all of Idaho

Montana Service Area
We provide WC services throughout all of Montana and P&C services in Missoula and the surrounding areas

Oregon Service Area
We provide WC and P&C services in Portland, E. Oregon, and the surrounding areas

Utah Service Area
We provide WC and P&C services throughout all of Utah

Washington Service Area
We provide WC services throughout all of Washington and P&C services in Yakima, E. Washington, and the surrounding areas

See the Area Map of our service coverage.