Assign a Claim — Zengler & Associates Inc.

Assign a claim

Insurance Company

Your Name

First Name

Last Name

Your Phone Number

(###)

###

####

Email Address

Date

Claim #

D/O/L

Name of Insured

First Name

Last Name

Address of Insured

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone of Insured

(###)

###

####

Contact

Coverage

Loss Location

Claimant

Address of Claimant

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email of Claimant

Details