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assignment submission

Please note Upon receipt of an assignment, we will contact you to confirm receipt and follow up for additional information. If you have any questions or your matter is urgent, please contact our home office directly at 413.282.0150. Thank you for the assignment!

Claim Number:

Policy Number :

Insured's First Name:

Insured's Last Name:

Contact Name (if other than insured) :

Contact Phone:

Contact Email:

Date of Loss :

Type of Loss:

Property Address:

Property City:

Property State :

Property Zip:

Description of Loss & Additional Instructions :

Your Company :

Your Name :

Your Email:

Your Phone:

Assignment Attachments

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assignment submission

ADVANCED ADJUSTMENT SERVICES, Inc.