Carolina Claims Service Inc. Assign A Claim

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Name of Person
Assigning Claim		  
Telephone No/Ext  
Company Assigning Claim  
Address  
Adjuster's E-mail  
Claim Number  
Type of Assignment  
Type of Claim  
Date of Loss      
Deductible  
Policy Forms which
Apply to Loss		  
Insured Name &
Address		  
Claimant Name &
Address		  
Loss Location  
Facts of Loss  
Special Handling
Instructions		  

 

 

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Carolina Claims Service Inc.111 Executive Center Drive
Suite 250
Columbia, SC  29210

© 2000 Carolina Claims Service Inc. 
All rights reserved.

Phone:  (803) 731-4005
Fax:  (803) 731-0320
 

Last Update:  04/03/06 11:36:49 AM