New Assignment

If you do not receive an assignment confirmation by fax or email by the next business day, please contact us.

Please complete all boxes below to submit a new assignment.

Name*
First Last
Company
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone
Fax
Email
Insurance Company
Named Insured
Insured Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Insured Phone
Loss Site Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Claim Number
Date of Loss
MM slash DD slash YYYY
Category (required):*
Scope of Work (required):*
Details of Loss (required) :*
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Comments
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Please call us with any questions at (781) 297-3500. Thank you for considering GAI Engineers.

For a printable version of our New Assignment Form that can be faxed or scanned/emailed to us, please click here.
Fax: 781-297-7050