Claim Evaluation

Your Public Insurance Adjuster experts

Please complete this short survey so we can evaluate your claim and provide you with the best possible assistance.

Today's Date

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What is your Name?

First

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Last

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Your Public Insurance Adjuster experts

What kind of property is this?

What best describes the property type?

Primary Residence

Rental Property

Commercial

Condominium

What is the address of the loss?

Address of Loss

Please specify an answer

Your Public Insurance Adjuster experts

What is your involvement?

What is your role in this property?

Owner

Renter

Business Owner

Other

Your Public Insurance Adjuster experts

Tell us about your loss

When did the loss occur?

Please select a date.

Type of loss the property sustained? (select 1 or more)

Fire

Water Damage

Windstorm & Rain

Tree Fall

Roof Collapse

Flood

Theft and/or vandalism

Earthquake

Describe the loss and the damage(s) to the property

Additional Loss Info

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Your Public Insurance Adjuster experts

Property Damage Information

Total square footage of the property

Total Square Feet

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How much of the property was damaged?

Damaged: 0%-100%

0% 100%

Has you received a payment/estimate from the Insurance Company? (N/A if no)

Estimate/Payment $

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Your Public Insurance Adjuster experts

Property Damage Information

Number of floors within your property?

Total # of Floors

Which Rooms were affected?

List all rooms

Please specify an answer

Is there currently a mortgage on the property?

Mortgage?

Your Public Insurance Adjuster experts

Your insurance company information

Who is your Insurance Company?

Insurance Co.

Please specify an answer

Where are you in the process & who is handling it?

Current Situation (1-8)

Desk Adjuster handling your claim

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Your Level of Frustration with your Insurance Co.

Happy Annoyed Angry

Your Public Insurance Adjuster experts

Your insurance company information

Upload your Insurance Policy and/or declarations page

Insurance Policy

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Your Public Insurance Adjuster experts

Leave your contact so we can reach out

Phone Number

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Email Address

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Your Public Insurance Adjuster experts

We received your inquiry! What happens next:

Inquiry received

Check inquiry

Contact

Consulting

Your Public Insurance Adjuster experts

Please complete this short survey so we can evaluate your claim and provide you with the best possible assistance.

What is your Name?

Your Public Insurance Adjuster experts

What kind of property is this?

Your Public Insurance Adjuster experts

What is your involvement?

Your Public Insurance Adjuster experts

Tell us about your loss

Your Public Insurance Adjuster experts

Property Damage Information

Your Public Insurance Adjuster experts

Property Damage Information

Your Public Insurance Adjuster experts

Your insurance company information

Your Public Insurance Adjuster experts

Your insurance company information

Your Public Insurance Adjuster experts

Leave your contact so we can reach out

Your Public Insurance Adjuster experts

We received your inquiry! What happens next:

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