New Assignments

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New Assignment Submission Form

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Your Company: *

Adjuster: *

Mailing Address: *

E-mail address: *

Office/Cell: *

Claim Number: *

Policy Number: *

Date of Loss: *

Type of Loss: *

Insured's Name *

Please have the assigned adjuster contact me before contacting the insured/claimant

I have additional documentation to submit (Please email directly to newclaims@c-and-o.com)

Insured's phone number(s) & address: *

Loss address: *

Loss description *

Deductible & Coverages (A, B, C, D): *

Policy Start & End Date: *

Special instructions *

Captcha (spam protection code) *

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APPRAISALS

ADJUSTMENTS

INVESTIGATIONS

Home Office:

(616) 956-9345

New Assignments:

newclaims@c-and-o.com

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