Claim File Submission Form

Contractor Name

Property and Policy Holder Information - (Not Contractor Info)

Address

Street Address *

City

State

Postal Code

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.