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Submit a Claim

To submit a claim to Subrogation Claims, Inc., please fill out our online claim form, or one of the optional versions below:

Best for printing and can be read on lots of different kinds of computers. You will need the free Acrobat Reader to view and print this file.

Open the Form using Microsoft Word or Word Pad
Fill out the form - you can even modify it to include additional text to describe your claim.
If you prefer, you can print the blank form and fill it out with a pen.
Mail or Fax to:
Subrogation Claims, Inc.
14241 N.E. Woodinville Duvall RD Suite #427
Woodinville WA 98072
or
fax to: (425) 821-3106
or
send via Email as an attachment to: newclaims197812@financialclaims.net

Name

Company Name

Address

Phone Fax

Auto Homeowners Other

Driver's Name

Owner's Name

Address

Is the above address a mail return? Yes No

POE

Home Phone Work Phone

Were there injuries? Yes No

Meds & UM - Still Open? Yes No

Is there a police report? Yes No

Please forward copy with proof.

IMPORTANT: WHEN DO THE STATUTES RUN?
BI $ PD $

Has your company already obtained judgment? Yes No

If yes, please include a copy of the entered Judgment for our records.

Principal $ Deductible $

Total $

Insured

Date of Loss

Claim #

Policy #