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Baldwin, New York 11510

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To submit an assignment, please complete the online form. If you would like a copy of your submission, please use your browser print settings and print a copy for your records. Once the information is complete, your information will be sent to United Claims Service, Inc. for processing. If you experience any technical difficulties, simply contact our office at: 1-800-843-4374.

Please email any additional information, documentation or records pertinent to the assignment to info@unitedclaims.com. Please include your claim number in the subject line of the email. Thank you and we look forward to working with you.

Contact Information

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First Name *
Last Name *
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Claim Number *
Email *
Address *
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 State
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Insured Information
Insured
Telephone Number
Additional Info
Insured Vehicle
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Witness(es)

Claimant Information
Claimant
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Claimants Vehicle
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Date of Accident
Time of Accident
Police Report
Location of Accident
Description of Accident
Assignment
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Security Code *
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