Claim File Submission Form

Contractor Name

Havok Restoration Of San Diego
Havok Restoration Of Bay Area
Havok Restoration Of West Palm Beach
Havok Restoration Of Plano
Havok Restoration Of Delaware
Havok Restoration Of Baltimore
Havok Restoration Of Central PA
Havok Restoration Of Philadelphia
Remedy Restoration - Boise
Remedy Restoration - East Bay
No elements found. Consider changing the search query.
List is empty.

Property and Policy Holder Information - (Not Contractor Info)

First Name

Last Name

Phone *

Email

Address

Street Address *

City

State

Postal Code

Type Of Claim

Decomp/Death/Blood Cleanup
Mold/Black Mold Cleanup
Water Damage
Fire/Smoke
Damage and Restoration
Other
Sewage/Black Water Cat 3.
Rebuild
No elements found. Consider changing the search query.
List is empty.

Date Of Loss

Insurer

Policy Number

Work Authorization Signed?

Yes

No

Upload Signed Work Authorization

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF

Assessment Of Damage

Include approx sqft, # of rooms, contamination, content removal, etc...

Initial Walk Through Photo(s) - Limit 10

PDF, DOC/DOCX, XLS/CSV, JPG/JPEG, PNG, GIF ( max 10 Files )

After the submission is received and reviewed, you will contacted with next steps.