General Placement Form 
 

Submitting a general placement form for a claim through the website is no longer active. 

 

Please submit claims directly through our e-mail address at Info@sampliner.com. 

 

Client’s who have access to the portal also have an option to submit claims through the portal. 

 

 

 

 

Phone: 212-239-4888

Fax:     212-239-4898

Address: 505 Eighth Avenue New York, NY 10018

 

                                                              

 
Submit A Claim
 
Please use this form to submit a claim to S.S. Sampliner & Co., Inc.

When complete, you may submit your claim directly to our Web site or print the form and fax it to us at:     (001) 1-212-239-4898.

For further assistance please call us at:
(001) 1-212-239-4888
 		  
Upload A File
   
You may attach additional supporting documents. Accepted file formats include:

Text 
Word
Comma Delimited
 Excel


 		  
Mail A Claim
   
 You may print this form and submit your claim by mail to:

S.S. Sampliner & Co., Inc.
505 Eighth Avenue
New York, NY 10018

Please include any supporting documentation with your claim.
 		  

 

   
 
Copyright © 2001 S.S. Sampliner & Co., Inc. All rights reserved