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Submit A Case
Please note: we DO NOT work with Wawanesa or USAA
Law Firm Name
Requester Email
Requester Address
Requester Phone
Insurance Company
Policy Number
Claim Number
Plaintiff Name:
Date of Loss
Other Required Information (Name, Address, DOB. For auto: vehicle information including year, make, model and color)
Insurance Type:
*
Required
Homeowners/Rental
Personal Auto
Umbrella
Commercial General Liability
Commercial Auto
Commercial Premises
Commercial Umbrella
Letter of Representation
Upload supported file (Max 15MB)
Upload File
Upload supported file (Max 15MB)
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