Commercial Claim

Initial Claim Questionnaire

Policy Information:

Business Name *

Contact Person Name *

Email *

Cell Phone *

Other *

Can we text you? *

Claim Address *

City *

State *

Zip code *

Is the Claim address the Same as Mailing Address? *

Insurance Information:

Insurance Information: *

Policy Number *

Claim Number *

Right to repair *

Mortgage Information:

Mortgage Company *

Loan Number *

Is the property for sale *

Are you currently refinancing? *

Structure Information:

Number of Buildings* *

Number of Residents* *

Usage *

Year Built *

Year Purchased *

Square footage of Building *

Has the property had Property Inspections?* *

Any Issues? (Please list them here) *

Do you have a maintenance department or maintenance records?* *

Roof Information:

Roof Material* *

How old is the roof *

Number of stories *

Is there a walkable roof?

Additional information

Easy to access property?

Additional information

Claim Information:

Were you onsite when the claim occurred?* *

Additional information

Do you have photos or videos of the claim?* *

if not, how long were you away?

Do you have prior claims on the property? *

Additional information

Closed / Paid / Repaired? *

Additional information

Siding Information:

How old is siding?* *

What is the siding material?* *

Contractor Information:

Do you have a contractor? *

Contractor information