Assignment Request

Assignment Request Form

*Required. Fields with a red asterisk require an input or the form cannot be submitted. If a required field is not applicable to your Assignment Request, please enter N/A or Not Applicable.

Company Name*

Your Name*

Phone Number*

Email*

Mailing Address*

Who referred you or how did you hear about us:

Insured Information

Your Insured*

Contact for Insured (if applicable)

Phone Number

Email

Claim Information

Your File Number*

Date of Loss*

Description of Loss*

Assignment Summary*

Date of Assignment Request to Rail Services

Time Sensitive Dates (Statute, Depositions, etc...)

Please include all relative claim documents (demands, invoices, police report, photos of damages, etc…) using the Document Upload button below. Once all relevant documents have been added, click the Submit button below.

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If there are no documents at this time, click the Submit button below.