First Name
Last Name
Email Address
Phone
Cell Phone
Fax No
Address
City
State
Zip Code
Comments
Claim Number
Date of Loss
Insured
Claimant
Exposure
 
Please enter the following information for a new assignment.
PHONE:
337-335-7563
EMAIL:
jason@blueclaims.com
FAX:
888-759-4309​​​​​
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