ERIE: 14 ½ South Lake St. North East, PA 16428
PITTSBURGH: 300 Mt. Lebanon Blvd., Suite 205C Pittsburgh, PA 15234

24-hour Claims Service!

New Assignment for Castle Claims Service

Contact Information & Assignment

Insured's Information

Loss Location and Claimant Information

Agent Information

Loss Information

First Name

Last Name

Company

Address (Line 1)

(Line 2)

City

State

ZIP

Phone

Your Claim #*

Assignment Instructions:

Phone #:

Alternate Phone #:

Policy #:

Company:

First Name:

Last Name:

Street Address:

Address 2:

City:

State

Zip:

Mortgagee:

Street Address:

Address 2:

City:

State

Zip

First Name:

Last Name:

Phone:

Street Address:

Address 2:

City:

State

Zip:

First Name:

Last Name:

Company:

Office Phone:

Cell Phone:

Street Address:

Address 2:

State

City:

Zip:

Country:

Date of Loss:

Type of Loss:

Unit:

Type of Adjustment:

Loss Description:

VIN #:

Deductible:

Wind Deductible:

Coverage A

Coverage B

Coverage C

Coverage D

Endorsements:

Name

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Contact

ERIE: 14 ½ South Lake St. North East, PA 16428
PITTSBURGH: 300 Mt. Lebanon Blvd., Suite 205C Pittsburgh, PA 15234
Tel: (412) 343-3223
Email: claims@castleclaims.com
24-hour Claims Service Available

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