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ClaimWizard Signup Form

1 Company Information

2 Account Information

3 Billing Information

Billing Contact Name*
First Last
Company*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Texas-based companies will be charged sales tax.
Billing Contact Email*
Company Phone*
Company Website

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How many assignable accounts do you need?*
An "assignable" is a user that can be assigned responsibility to a claim such as an adjuster, estimator, etc. These users can only access claims assigned to them.
Monthly Subscription Fee
$0.00
1 Assignable Accounts - NO Staff
Up To 3 Assignable Accounts
4 Assignable Accounts
5 Assignable Accounts
6 Assignable Accounts
7 Assignable Accounts
8 Assignable Accounts
9 Assignable Accounts
*ClaimWizard Assignable Account Roles:
- Property Adjuster
- ALE Adjuster
- Contents Adjuster
- Appraiser
- Estimator
- Loss Consultant
- Apprentice / Trainee
- Umpire
- Attorney
- Inside Adjuster
- Outside Adjuster
- Claim Specialist
Assignable Account (Pro)*
First Name Last Name Email
Assignable Account #1*
First Name Last Name Email Account Role
Assignable Account #2
First Name Last Name Email Account Role
Assignable Account #3
First Name Last Name Email Account Role
Assignable Account #4
First Name Last Name Email Account Role
Assignable Account #5
First Name Last Name Email Account Role
Assignable Account #6
First Name Last Name Email Account Role
Assignable Account #7
First Name Last Name Email Account Role
Assignable Account #8
First Name Last Name Email Account Role
Assignable Account #9
First Name Last Name Email Account Role
Office Staff Information
Click the + button to add more accounts. Office Staff accounts have access to all claims for processing purposing but are not assigned to specific claims.
First Name Last Name Email Account Role (Staff or Manager)
Does your company have Sales Representatives or Solicitors?*
- Yes
- No
These accounts are in addition to assignable users above.
Sales Representative Information
Click the + button to add more accounts.
First Name Last Name Email
Notes & Additional Information:
Enterprise: Account Setup
Thank you for your interest in a ClaimWizard Enterprise account. Enterprise accounts are best for businesses with 10 or more assignable accounts. Please call our Sales Team at 856-705-0201 to continue.

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Credit Card*

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Name
This field is for validation purposes and should be left unchanged.

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Please note that your information needs to be reviewed for accuracy by the ClaimWizard team before any user accounts are activated.

ClaimWizard Signup Form

1 Assignable Accounts - NO Staff

Up To 3 Assignable Accounts

4 Assignable Accounts

5 Assignable Accounts

6 Assignable Accounts

7 Assignable Accounts

8 Assignable Accounts

9 Assignable Accounts

Enterprise: Account Setup

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