ClaimWizard Signup for ClaimWizard •

ClaimWizard Signup Form

1Company Information

2Account 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 Owner Name/Email*
Company Phone*
Company Website
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
How did you hear about ClaimWizard?*
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
Assignable Account (Pro)*
First Name Last Name Email
Assignable Account #1 - First Name*
Assignable Account #1 - Last Name*
Assignable Account #1 - Email*
Email account must exist before setting up in ClaimWizard
Assignable Account #1 - Role(s)*
Multiple roles can be included on the same license fee.
Assignable Account #2 - First Name
Assignable Account #2 - Last Name
Assignable Account #2 - Email
Email account must exist before setting up in ClaimWizard
Assignable Account #2 - Role(s)
Multiple roles can be included on the same license fee.
Assignable Account #3 - First Name
Assignable Account #3 - Last Name
Assignable Account #3 - Email
Email account must exist before setting up in ClaimWizard
Assignable Account #3 - Role(s)*
Multiple roles can be included on the same license fee.
Assignable Account #4 - First Name
Assignable Account #4 - Last Name
Assignable Account #4 - Email
Email account must exist before setting up in ClaimWizard
Assignable Account #4 - Role(s)
Multiple roles can be included on the same license fee.
Assignable Account #5 - First Name
Assignable Account #5 - Last Name
Assignable Account #5 - Email
Email account must exist before setting up in ClaimWizard
Assignable Account #5 - Role(s)
Multiple roles can be included on the same license fee.
Assignable Account #6 - First Name
Assignable Account #6 - Last Name
Assignable Account #6 - Email
Email account must exist before setting up in ClaimWizard
Assignable Account #6 - Role(s)
Multiple roles can be included on the same license fee.
Assignable Account #7 - First Name
Assignable Account #7 - Last Name
Assignable Account #7 - Email
Email account must exist before setting up in ClaimWizard
Assignable Account #7 - Role(s)
Multiple roles can be included on the same license fee.
Assignable Account #8 - First Name
Assignable Account #8 - Last Name
Assignable Account #8 - Email
Email account must exist before setting up in ClaimWizard
Assignable Account #8 - Role(s)
Multiple roles can be included on the same license fee.
Assignable Account #9 - First Name
Assignable Account #9 - Last Name
Assignable Account #9 - Email
Email account must exist before setting up in ClaimWizard
Assignable Account #9 - Role(s)
Multiple roles can be included on the same license fee.
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 MUST EXIST BEFORE SIGNING UP) Account Role (Staff or Manager)
Does your company have Sales Representatives or Solicitors?*
These accounts are in addition to assignable users above.
- Yes
- No
Sales Representative Information
Click the + button to add more accounts.
First Name Last Name Email (ACCOUNT MUST EXIST BEFORE SIGNING UP)
Notes & Additional Information:
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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.

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

ALL EMAIL ACCOUNTS **MUST** BE CREATED AND LIVE BEFORE SETTING UP AN ACCOUNT IN CLAIMWIZARD.

First Name	Last Name	Email (ACCOUNT MUST EXIST BEFORE SIGNING UP)	Account Role (Staff or Manager)

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