Contact usHave questions? Email us at info@360bgc.com. If you would like to submit a new assignment, please do so below. SUBMISSION FORM Submission Form SUBMITTED BY: Name * First Name Last Name Title * Email * Phone * (###) ### #### ASSIGNMENT INFORMATION: Insured Insured Contact First Name Last Name Insured Contact Email Insured Contact Phone (###) ### #### Loss Address Address 1 Address 2 City State/Province Zip/Postal Code Country Building Identifier (as applicable) Date of Loss MM DD YYYY Project Type Appraisal Builders Risk Desk Analysis Environmental Fire Flood Hail Legal Other Vandalism Water Wind Building Type Apartment / Multi-Family Commercial High-Rise Commercial Warehouse Education Hospital / Medical Office Building Infrastructure Industrial Office Other Public Municipality Religious Residential Residential (High-End) Restaurant Retail Project Information CARRIER / IA INFORMATION: Carrier Carrier Claim # Policy # Carrier Adjuster First Name Last Name Carrier Adjuster Title Carrier Adjuster Email Carrier Adjuster Phone (###) ### #### Examiner First Name Last Name Examiner Email Examiner Title Examiner Phone (###) ### #### IA Company IA File/Claim # IA Adjuster First Name Last Name IA Adjuster Title IA Adjuster Email IA Adjuster Phone (###) ### #### Budget $ We genuinely appreciate the opportunity! One of our consultants will contact you soon.
