Claim File Submission Form

Contractor For Claim

Property and Policy

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
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

Assessment Of Damage

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

Initial Walk Through Photo(s) - Limit 10

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