Asset Protect - LeaseTerm Solutions

* Your Property Zip Code

* Property Name

* Person Submitting Claim

* Resident First Name

* Resident Last Name

* Address or Apartment Number

* Date of Loss

* Phone Number

2nd Phone Number

* Email

* Cause of Loss

Do you have a Fire Report? YesNo

Do you have a Police Report? YesNo

* Please Enter a Brief Description of Loss This policy contains a $500 Deductible for Losses and $1000 Burglary.
Are your Losses Over the Deductible?
[More Details] YesNo Please attach the following documents (if applicable)

Pictures of the damaged items, List of items lost with replacement value, Fire Report, Police Report (Required for Burglary). Uploaded files must be in one of the following formats: pdf, jpg, tif, docx

NOTE: You can select multiple files by holding the "Ctrl" key and clicking the files in the selection window.

Claim Submission