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Speak those things that are not as though they were.
(Rom. 4:17)

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Type of claim assignment*
- Casualty
- Property
- Catastrophe Services
Description of Assignment(s)*
Name*
First Last
Company
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Date of Loss*
Date Format: MM slash DD slash YYYY
Location of Loss*
Claim Number*
Insured's Name*
First Last
Insured's Phone*
Claimant's Name*
First Last
Claimant's Phone*
Assignment Notes*
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