Property Assignment Form Please complete and submit the following information regarding your claim assignment or email your assignment to NewClaims@custard.comYour assignment will be sent to our HOTLINE for immediate processing.Required fields are marked with *For technical assistance, please contact our IT Department at 1-877-477-2223 (Monday through Friday between 8:00AM and 5:00PM Eastern) Location of Adjuster AssignmentAssignment City, State, and CountryCity -- Please Select -- Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories and Nunavut Nova Scotia Ohio Oklahoma Ontario Oregon Other Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon State / ProvinceAustralia Bermuda Canada Finland France Germany Hong Kong Israel Mainland China (People's Republic of China) Mexico Netherlands Panama Puerto Rico Singapore South Africa Sweden Taiwan (Republic of China) Turkey United Kingdom USA CountrySubmitted ByNameFirst Name*Last Name*Contact InformationPhone Number*Email Address*Cell Phone NumberFax NumberCompanyCompany Name*Branch / Office NumberAddressAddress Line 1*Address Line 2City* -- Please Select -- Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories and Nunavut Nova Scotia Ohio Oklahoma Ontario Oregon Other Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon State / Province*ZIP / Postal Code*Australia Bermuda Canada Finland France Germany Hong Kong Israel Mainland China (People's Republic of China) Mexico Netherlands Panama Puerto Rico Singapore South Africa Sweden Taiwan (Republic of China) Turkey United Kingdom USA Country*Report To (if different from above)NameFirst NameLast NameContact InformationPhone NumberEmail AddressCell Phone NumberFax NumberPolicy InformationPolicy DetailsPolicy NumberPolicy Effective DateLoss InformationCustomer Claim NumberBrief Description of Loss* Date of Loss*Location of LossWere Police Called? Yes No Name of Police Dept.Was Fire Dept. Called? Yes No Insured InformationInsured Person / Company*NameInsured First NameInsured Last NameInsured AddressInsured Address Line 1Insured Address Line 2Insured City -- Please Select -- Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories and Nunavut Nova Scotia Ohio Oklahoma Ontario Oregon Other Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Insured State / ProvinceInsured ZIP / Postal CodeAustralia Bermuda Canada Finland France Germany Hong Kong Israel Mainland China (People's Republic of China) Mexico Netherlands Panama Puerto Rico Singapore South Africa Sweden Taiwan (Republic of China) Turkey United Kingdom USA Insured CountryContact InformationInsured Home Phone NumberInsured Email AddressInsured Cell Phone NumberInsured Work Phone NumberClaimant InformationNameClaimant First NameClaimant Last NameAddressClaimant Address Line 1Claimant Address Line 2Claimant City -- Please Select -- Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories and Nunavut Nova Scotia Ohio Oklahoma Ontario Oregon Other Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Claimant State / ProvinceClaimant ZIP / Postal CodeAustralia Bermuda Canada Finland France Germany Hong Kong Israel Mainland China (People's Republic of China) Mexico Netherlands Panama Puerto Rico Singapore South Africa Sweden Taiwan (Republic of China) Turkey United Kingdom USA Claimant CountryContact InformationPhone NumberEmail AddressCell Phone NumberWork Phone Number ZIP files will get stripped from the assignment prior to sending it to HOTLINE. 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