Company Name
*
Contact First Name
*
Contact Last Name
*
Phone Number
*
Email
*
Description of claim of damages?
*
Adjusters Estimate?
*
Yes
No
Upload Adjuster Estimate files
EagleView or Aerial Report?
*
Yes
No
Upload EagleView/Aerial report files
Other Images?
Yes
No
Upload Images
Property Owner/Job Name
*
Type of Loss
Date of Loss
Address
*
City
*
State
*
Postal code
*
Add Overhead & Profit?
*
Yes
No
Permit Fee
Insurance Information?
Yes
No
Insurance Information
Insurance Name
Claim Number
Policy Number
Upload insurance files
Any additional information we should know?
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