Submit
Assignment


We provide valuable insurance and risk management services to insurance companies, self-insured corporations, claim adjusting firms and governmental entities.

New Claim


Client information
Company:
Address:
City, State, & Zip:
Adjuster Name:
Adjuster Email:
Phone:
Extension:
Fax :
Insured Information
Insured:
Address:
City, State, & Zip:
Phone:
Phone:
Phone:
Claimant information
Claim:
Address:
City, State, & Zip:
Phone:
Phone:
Phone:
Coverage information
Claim Nº:
Policy Nº:
Type of Policy:
Effective date:
Coverage amounts:
A:
B:
C:
D:
Deductible:
Lien Holder:
Loss information
Loss Date:
Loss Location:
Description of loss:
Special instruction:
Full Adjustment:
Agreed Apraisal:
Attach files:

Contact Us


Our solutions are exactly that,
solutions. We have the flexibility
to provide you with a customized
and evolving product to meet
and exceed your needs.


ENGAGE SOLUTIONS, INC.
P. O. BOX 802724
Aventura, Florida 33280
1 (800) 977-3642