© Copyright Claims Consultants LLC.  All Rights Reserved.  Website design by North Mobile Internet Services, Inc.

Electronic Claim Assignment

Nationwide Toll Free

 (866) 654-9777

Claims Consultants LLC 5485 Seventh Street Satsuma, AL 36572 Telephone (251) 653-9777 Toll Free (866) 654-9777 Property Fax (251) 653-9990
All claim assignments are submitted to our home office. Specific field adjuster contact information will be confirmed and provided based on loss location and type of assignment. Please complete the following information. We will contact you and acknowledge receipt
Untitled Document

Insurance Company Information:

Insurance Company Name:
Address:
City, State, Zip:
Adjuster Name:
Adjuster Phone Number:
Adjuster Email Address:

Policy Information:

Company:
Coverages and Deductibles:
Type of Policy:
Forms:

Claim Information:

Claim Number:
Date of Loss:
Loss Type:
Description of Loss:

Insured Contact Information:

Insured Name:
Loss Address:
City, State, Zip:
Residence Phone:
Cell Phone:
Business Phone:
Contact Name:
Contact Phone:
Mortgage:

 

Comments:

 

© Copyright Claims Consultants LLC.  All Rights Reserved.  Website design by North Mobile Internet Services, Inc.

Electronic Claim Assignment

Nationwide Toll Free

 (866) 654-9777

Claims Consultants LLC 5485 Seventh Street Satsuma, AL 36572 Telephone (251) 653-9777 Toll Free (866) 654-9777 Property Fax (251) 653-9990
All claim assignments are submitted to our home office. Specific field adjuster contact information will be confirmed and provided based on loss location and type of assignment. Please complete the following information. We will contact you and acknowledge receipt

Nationwide Toll Free

 (866) 654-9777

Nationwide Toll Free  (866) 654-9777