Please use this form to provide Nancy with case details

• Today's date

  -- mm/dd/yy

  
  

• If you are presently an account of Nancy's please provide client information:

  First Name
  Last Name

           Case number

• Catastrophic or nonCatastrophic Catastrophic Non-Catastrophic

• Select any of the following options that apply:

  New Case
  Transfer of Old Case
  Change of Supplier
  Change of Adjuster
  Change of Nancy Green Associate

   

• Please summarize the case.