Posted: 1/24/2013

Request a 30-Day Extension

This extension allows the responding company an additional 30 days to reply. The 30-day extension is available without charge, one time per file.

Name:

Responding Company:

E-mail Address:

Phone:

NAS Case Number:

- OR -

Claim Number:

Insured's Last Name:

By checking this box, you are requesting a one time 30-day extension on the above referenced file.

Comments: