Order

To refer a case for investigation:

Contact our office at telphone number 800-651-0460 and speak with one of our account representatives to discuss solutions to your claim.

Print out an order form and fax your referral to 800-651-0496.

Download our electronic order form and email your referral to assignment@claimsbureau.com or use our online order form below.

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Customer Information

If you are a new customer, enter the following information:
and      

Claimant/Subject information

  
Claim #
 Date of Loss
Assured
Subject Name
Address
City
State and Zip Code   
 Phone
D.O.B.
 SSN
Height
Weight
Marital 
Additional Description
Injury
Employer 
Occupation
Motor Vehicle
Attorney Information
Attorney Address

Remarks/Specific Instructions:

Paste Case Info Here:

After entering data, click on the Submit Request button only once.
You will then be sent to a confirmation page.