Claim Submission

The filling out of this placement form and the submission of same constitutes a contract between your office and Williams, Charles & Scott LTD. (hereafter known as WCS). Please click here to view our Terms & Conditions document. If you are submitting consumer claims, please contact our sales department first:

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Placement Form

Your Company Information

Your Customer's Information

Attach supporting documents from your computer or submit other documentation via email to or fax to 631-462-5751

Total size should be below 40MB. If you have larger files or more than five files, you can use this function multiple times and use the comments section to let us know this is part of the same submission.