Auto claim assignments can be conveniently submitted electronically over the Internet. Simply fill out the requested claim information on the form and email it back to us. If an ABRA store is not initially selected, we will assist your customer in selecting a convenient store near their home or work. We will process the assignment and provide you verification via email.

*Date:
*Company:
*Claims Handler First Name:
*Claims Handler Last Name:
*Claims Handler Telephone:
*Claims Handler Fax:
*Claim #:
Date of Loss:
*Owner Last Name:
*Owner First Name:
Owner Deductible:
Owner Address 1:
Owner Address 2:
Owner City:
Owner State:
Owner ZipCode:
Owner Country:
Owner Home #:
Owner Work #:
*Vehicle Year:
*Vehicle Make / Type:
*Vehicle Model / Type:
VIN #:
*Insured or Claimant:	Insured   Claimant
Rental Coverage:
Total Loss:	Yes   No
Need Towing:	Yes   No
*Committed to coverage:	Yes   No
ABRA Location:	Select a location Littleton, Colorado Boulder, Colorado Denver SE, Colorado Westminster, Colorado Wheat Ridge, Colorado Chatfield, Colorado Lakewood, Colorado Colorado Glass, Colorado Colorado PDR, Colorado Longmont, Colorado Aurora, Colorado Parker, Colorado Colorado Springs, Colorado Highlands Ranch, Colorado Thornton, Colorado Buckhead, Georgia Cumming, Georgia Kennesaw, Georgia Morrow, Georgia Georgia PDR, Georgia Conyers, Georgia Fayetteville, Georgia Peachtree City, Georgia Georgia Glass, Georgia Lilburn, Georgia Roswell - Dunwoody, Georgia Suwanee, Georgia Carrollton, Georgia Douglasville, Georgia Newnan, Georgia East Marietta, Georgia Lawrenceville, Georgia Marietta, Georgia Dubuque, Iowa Hiawatha, Iowa Dubuque Glass, Iowa Dubuque PDR, Iowa Hiawatha Glass, Iowa Iowa City, Iowa Princeton - Estimating Center, Minnesota Duluth, Minnesota Rochester Glass, Minnesota Red Wing, Minnesota Ham Lake, Minnesota Brooklyn Park, Minnesota Faribault, Minnesota St. Cloud, Minnesota Roseville, Minnesota Minnesota Twin Cities PDR, Minnesota Rochester, Minnesota Bloomington - West, Minnesota St. Cloud Glass, Minnesota Twin City Metro Area Glass, Minnesota Marshall Glass, Minnesota New Hope, Minnesota Chanhassen Glass, Minnesota Woodbury Glass, Minnesota Rogers, Minnesota Bloomington - East, Minnesota Burnsville, Minnesota Chanhassen, Minnesota Coon Rapids, Minnesota Eagan, Minnesota Eden Prairie, Minnesota Apple Valley, Minnesota Elk River, Minnesota Forest Lake, Minnesota Fridley, Minnesota Long Lake, Minnesota Hopkins, Minnesota Maplewood, Minnesota Marshall, Minnesota Plymouth, Minnesota St. Louis Park, Minnesota Midway, Minnesota Stillwater, Minnesota Woodbury, Minnesota West St. Paul, Minnesota Horn Lake, Mississippi Horn Lake PDR, Mississippi Shallotte, NorthCarolina Castle Hayne, NorthCarolina Bismarck, NorthDakota Grand Forks Glass, NorthDakota Grand Forks, NorthDakota Bismarck Glass, NorthDakota Bismarck PDR, NorthDakota Grand Forks PDR, NorthDakota Rapid City Glass, SouthDakota Aberdeen Glass, SouthDakota Sioux Falls Glass, SouthDakota Aberdeen, SouthDakota Rapid City, SouthDakota Sioux Falls, SouthDakota Chattanooga, Tennesee Cordova, Tennesee Covington Pike, Tennesee Elmore Road, Tennesee Mount Moriah, Tennesee Shelby Drive, Tennesee Cleveland, Tennesee Memphis Glass, Tennesee Chattanooga Glass, Tennesee Cleveland Glass, Tennesee Memphis PDR, Tennesee Hixson, Tennesee Wolfchase, Tennesee Utah PDR, Utah Sandy, Utah Utah Glass, Utah Murray, Utah South Salt Lake City, Utah Eau Claire, Wisconsin Brookfield, Wisconsin Delafield, Wisconsin Eau Claire Glass, Wisconsin New Berlin, Wisconsin Kenosha, Wisconsin Oconomowoc, Wisconsin Madison - East, Wisconsin Madison - West, Wisconsin West Allis, Wisconsin Wisconsin Glass, Wisconsin Wisconsin PDR, Wisconsin
Area of Damage/Special Notes:
* this is a required field