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)

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

Claim Submission