Financial Claims

Business and Subrogation Specialists

Client Access Coming Soon…

Assign New Files

To submit a claim to Financial Claims, please fill out our online claim form, or one of the 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.

1) Print the Form
2) Fill it out
3) Attach any additional files that support your claim
4) Mail or Fax to:

FINANCIAL CLAIMS
Mail: P.O. Box 3029 Kirkland, WA 98083-3029

Fax: (425) 821-3106

Microsoft Word Version

1) Open the Form using Microsoft Word or Word Pad
2) Fill out the form - you can even modify it to include additional text to describe your claim.
3) If you prefer, you can print the blank form and fill it out with a pen.
4) Mail or Fax to:

FINANCIAL CLAIMS
Mail: P.O. Box 3029 Kirkland, WA 98083-3029

Fax: (425) 821-3106

5) Or send via Email as an attachment to:

newclaims197812@financialclaims.net

Online Claim Form

Client Info

Name

Company Name

Address

Phone Fax

Auto Homeowners Other

Claimant Info

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.

Theory of Liability

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 #