Assign A Subrogation Recovery File

Your Name*

Please let us know your name.
Your Email*

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Your Phone Number*

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Your Company*

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Company Type

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Claim Number*

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Loss Date*

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Lump Sum Authority*

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Attach Estimate*

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Proof of Payment*

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Attach Police Report

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Adjuster Notes*

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Notes*

Special Notes
Authorization

By requesting an assignment via our online form you agree to a 20% contingency and we agree to handle your file professionally and effectively. Invalid Input
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