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Claim Submission
* Your Property Zip Code
* Property Name
* Person Submitting Claim
Resident
Property Management
* Resident First Name
* Resident Last Name
* Address or Apartment Number
* Date of Loss
* Phone Number
2nd Phone Number
* Email
* Cause of Loss
Select...
Fire
Water
Smoke
Wind
Hail
Lightning
Burglary
Other
Do you have a Fire Report?
Yes
No
Do you have a Police Report?
Yes
No
* 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
]
Yes
No
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)
NOTE:
You can select multiple files by holding the "Ctrl" key and clicking the files in the selection window.