Company Mailing Address

Preferred Method of Contact

Loss Location See Location in Maps

Phone Number

Additional Phone Number

Insured's Email Address

Third Party Point of Contact

Third Party's Phone Number

Third Party's Email Address

Insured Type

Roof Type

Asphalt

Slate

Membrane

Wood Shake

Metal

Clay Tile

Other Buildings

If yes, explain:

Steep Roof

Roof Pitch:

Brief Description of Loss (What Happened?):

What do you want us to do? (Scope of Work):

Repair Recommendation Needed

Roof Measurements Needed

Tarp Present

Interior Measurements Needed

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Claims/Adjuster Info

Client Name:

Company:

Phone Number:

Email:

Company Mailing Address:

Preferred Method of Contact:

Claim Information

Date of Loss:

Claim Number:

Insured's Name:

Loss Location:

Phone Number:

Additional Phone Number:

Insured's Email Address:

Third Party Point of Contact:

Third Party's Phone Number:

Third Party's Email Address:

Insured Type:

Building Information

Building Type:

Number of Stories:

Garage:

Roof Type:

Other Buildings:

Explanation:

Steep Roof:

Roof Pitch:

Scope of Project

Brief Description of Loss:

Scope of Work:

Repair Recommendations Needed:

Roof Measurements Needed:

Tarp Present:

Interior Measurements Needed:

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Claims/Adjuster Info

Claim Information

Building Information

Scope of Project