Name:

State:

Zip Code:

Email:

Phone:

Fax:

State you'd like to work in:

If you are an interested adjuster in a state not listed above, please call John Hawkins at (818) 581-6416 or fill in the state and provide additional information below.

NOTE: The position offered will be a 1099 (Independent Contractor) status. Applicants must provide proof of licensing in the applicable state as well as a W-9 and sign an independent contractor agreement.

A Churchill Claims Services e-mail address will be provided. Applicants must provide their own home/business number, cell phone and fax number which will be listed on our web site.

A P.O. Box can be set up for mail if the applicant does not wish to have his/her home address listed on our web site. This will be paid for by Churchill Claims Services.