Submit an Assignment

Submitting an assignment to Croft ClaimWorks, L.C. is quick and easy—just complete the information below and click the submit button when you are finished.

 

CLIENT INFORMATION
Name*
Title
Organization
Street Address*
City
State/Province
Zip/Postal Code
Country
Work Phone*
Home Phone
FAX
E-mail*
INSURED INFORMATION
Claim Number
Insured/Policy holder's name
Insured/Policy's holder's address
Insured/Policy holder's home phone
Insured/Policy holder's business phone
Location of loss ( City/State )
Description of loss
Date of Loss	-- mm/dd/yy
Time of Loss	-- hh:mm
Were the police called	Yes  No
Name of Police Dept
LOSS INFORMATION
Name
Title
Organization
Street Address
City
State/Province
Zip/Postal Code
Country
Work Phone
Home Phone
E-mail
Vehicle involved
Year/Make/Model
Damage Description
Driver's Name
Driver's Phone
Injured Party Names
Witness Information

 

Toll Free Local Fax After Hours

877-856-8396 972-783-9505 972-669-9090 214-952-6584

 

Member