Submit an Assignment

Please fill out the form below. If you have any questions, please give us a call at 800.562.7966. Required fields are represented by an asterisk.
Section 1: Assignment Sent In By
Your Name*
FirstLast
Your email address
Enter EmailConfirm Email
Primary Phone Number*
Secondary Phone Number
Company Name*
Company Address
Street AddressCityStateZIP Code
Company Claim Number*
Policy Number
Date Issued
MM
DD
YYYY
Expiration
MM
DD
YYYY
Section 2: Type of Coverage
Select Your Type(s) of Coverage
- Casualty Claim
- Auto/Commercial Auto
- Property Claim
- Workers Compensation
- Vehicle Appraisal
- Other
Section 3: Insured
Named Insured*
FirstLast
Address of Insured
Street AddressCityStateZIP Code
Primary Phone Number of Insured
Secondary Phone Number of Insured
Email Address of Insured
Vehicle Information (Year, Make, Model)
Vehicle Identification Number (VIN)
Section 4: Coverage Forms and Endorsements
Upload Files
Drop files here or
Or, Copy and Paste Text Here
Section 5: Facts of Loss
Description of Loss
Date of Loss
Time
: HH
MM
Location
Street AddressCityStateZIP Code
Police Report Number
Section 6: Claimant and Witness Information
- Claimant 1 -
Claimant 1 Name
FirstLast
Claimant 1 Phone Number
Claimant 1 Email
Claimant 1 Address
Street AddressCityStateZIP Code
Insurance Carrier
Vehicle Information (Year, Make, Model)
Vehicle Identification Number (VIN)
Add Another Claimant?
- Yes
- No
- Claimant 2 -
Claimant 2 Name
FirstLast
Claimant 2 Phone Number
Claimant 2 Email
Claimant 2 Address
Street AddressCityStateZIP Code
Insurance Carrier
Vehicle Information (Year, Make, Model)
Vehicle Identification Number (VIN)
Add Another Claimant?
- Yes
- No
- Claimant 3 -
Claimant 3 Name
FirstLast
Claimant 3 Phone Number
Claimant 3 Email
Claimant 3 Address
Street AddressCityStateZIP Code
Insurance Carrier
Vehicle Information (Year, Make, Model)
Vehicle Identification Number (VIN)
- Witness 1 -
Witness 1 Name
FirstLast
Witness 1 Phone Number
Witness 1 Email
Witness 1 Address
Street AddressCityStateZIP Code
Add Another Witness?
- Yes
- No
- Witness 2 -
Witness 2 Name
FirstLast
Witness 2 Phone Number
Witness 2 Email
Witness 2 Address
Street AddressCityStateZIP Code
Section 7: Special Instructions
Additional Instructions
Add Any Other Attachments Here
Drop files here or

ABOUT US

Established in 1968, American Claims Service, Ltd. is an independent adjustment company based in Chicago that provides coverage to a large service area with fast, reliable, 24/7 service by professional adjusters.

SUBMIT AN ASSIGNMENT

Looking to submit an assignment? Click the button below.

Submit an Assignment

CONTACT US

We proudly serve the Chicagoland, Northeast Illinois, and Northwest Indiana areas. Here's how you can reach us.

1.800.562.7966
info@americanclaims.com

Submit an Assignment

Section 1: Assignment Sent In By

Section 2: Type of Coverage

Section 3: Insured

Section 4: Coverage Forms and Endorsements

Section 5: Facts of Loss

Section 6: Claimant and Witness Information

- Claimant 1 -

- Claimant 2 -

- Claimant 3 -

- Witness 1 -

- Witness 2 -

Section 7: Special Instructions