SLADE & DARNELL

                                                                                                    ADJUSTERS, INC

                                                             310 Office Plaza • P.O. Box 12877 • Tallahassee, Florida 32308-2877 • Phone (850) 877-6115 • Fax (850) 656-3818 

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Multiple Line Adjusters & Appraisers Serving North Florida & South Georgia Since 1958

You can now assign claims online.  After you complete and submit the form, it will be sent to us via e-mail.

(Fields in red are required).

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TYPE OF ASSIGNMENT/CLAIM:

Please enter type of assignment:

Check to receive an acknowledgement of assignment

Date of Loss:  

Claim/Policy Number:                        Please Choose One:

                    

Policy Effective Dates (if applicable):

                to   

COMPANY/CLIENT CONTACT INFORMATION:

Please provide Company Contact information:        

First Name  

Last Name 

Title  

Company/Client   

Street Address

Mailing Address

City

State    

Zip Code

Phone

  Ext. 

FAX

E-mail

INSURED INFORMATION:

Please provide the following Insured information:

First Name

Last Name 

Or Company Name

 
Street Address
Mailing Address
City

State
Zip Code
Home Phone Other Phone
Contact First Name

Contact Last Name

Home Phone Other Phone

CLAIMANT INFORMATION:

Please provide the following Claimant information:

First Name

Last Name

Or Company Name

 
Street Address
Mailing Address
City

State
Zip Code
Home Phone Other Phone
Contact First Name

Contact Last Name

Home Phone Other Phone

Please enter assignment instructions below.


 
Send mail to claims@sladedarnell.com with questions or comments about this web site.
Copyright © 2006 Slade & Darnell Adjusters, Inc.
Last modified: 03/02/10