Insurance Claim Assignment

Insurance Agents, Insurance Adjusters, and Public Adjusters, assign your claims here.

YOUR CONTACT DETAILS

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Carrier Name *

Referral Type *

Restoration Mitigation Appraisal Estimates

INFORMATION ABOUT THE INSURED RESIDENT

Insured Resident First Name *

Insured Resident Last Name *

Street Address of the Insured Resident *

City *

Postal Code *

State / County *

Insured Resident Phone Number (Mobile) *

Insured Resident E-mail Address *

Is the Owner Information Different? *

YES NO

Can We Call The Insured Resident Directly? *

YES NO

POLICY INFORMATION

Claim Reference *

Policy Number *

Deductible Amount *

INFORMATION ABOUT THE LOSS

Loss Date *

Type of Loss *

Is it an EMERGENCY? *

YES NO

OTHER INFORMATION *

SEND NOW

County Action Restoration
1313 West Chester Pike
West Chester, PA 19382
info@countyservicesinc.com

24/7/365 EMERGENCY LINE:
610-918-9698

SUN-SUN OPEN 24 hours

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Insurance Agents, Insurance Adjusters, and Public Adjusters, assign your claims here.

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