Catastrophe Assignment Form

Using the form below, please enter your inspection, claim, or request information, as well as your company information. Provide details of your request/claim, then Click the Submit Button.

Or, simply click here to download our Assignment Form in PDF format, to complete and fax to us.

Your Information:

Name:

Company:

E-mail:

Address:

City:

State:

Zip/Postal:

Phone :

Fax :

Other:

Assignment Details:

Claim No:

DOL:

Insured:

Loss Location:

City:

State:

Zip/Postal:

Phone:

Fax:

Other:

Scope of Loss:

Facts of Loss:

Please also forward additional information such as accident reports, repair receipts, fire reports, plumbing reports, etc.

    800.216.7268 (toll free)
    Fax: 800-996-8377
    info@pronetgroup.com