Greentree & Associates Tour - Assignment Form

The Greentree and Associates assignment form (sample below) has been developed to provide our clients with an easy to use template for entering data in our system.

Step One: Complete each section, then click 'Process' to initiate the assignment process.

Step Two: Should the completion of an assignment require additional documentation, click 'Attachment' prior to submitting the form.

These two easy to follow steps are all that's necessary to begin the process of assigning an account.

Click 'Client Page' to view available options once an account has been assigned.


Assignment Date:  
Client Code:  
Your Name:  
Company:  
Adverse:  
Contact:  
Address:  
City:  
State:  
Zip:  
Phone(s):  
Other Phone:  
Loss Date:  
Claim Number:  
Balance Owed:  
Claim Amount: $  
Total Amt Paid: $  
Brief Explanation:  
 
 
Please Check One: First Placement Second Placement
 
Type of file: Commercial    
  Subrogation    
  Deductible    
  Overpayment    
  Arbitration  
 
Attach a file: