Assignment Form

You may e-mail your assignment to mail@gcgable.com or phone us at 716-856-6561 or 1-800-886-6561. You may also wish to print out following form, fill in and mail or fax to:

Your Company:___________________Claim#________

Assigned By:_________________Policy#________
Phone/address:____________________________

Insured:__________________________________
Claimant(s):_______________________________
Date of Loss:______________________________

Type of Loss:______________________________

Insured contact info:_________________________

Claimant(s) contact info: _____________________

Details of loss:





Instructions:






Notes/Remarks:

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