Public Service Adjusting
Valparaiso, IN
Sturgis, MI
Fort Myers, FL
Dallas, TX
Baton Rouge, LA
Sandusky, OH
(844) 772-4872
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Our Services
Public Insurance Adjuster
Loss Consultants
Appraisal / Umpire
Pre Loss Consultation
Yearly Policy Review
Resources
The FIRM
How To File A Claim
American Policyholder Association
State Specific
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Meet The Team
Contact Us
Menu
Home
Our Services
Public Insurance Adjuster
Loss Consultants
Appraisal / Umpire
Pre Loss Consultation
Yearly Policy Review
Resources
The FIRM
How To File A Claim
American Policyholder Association
State Specific
Talk To An Attorney
Meet The Team
Contact Us
Contact Us
Phone: (504) 233-8706
Metairie, LA
Phone: (219) 706-5973
Portage, IN
Contact Us
Home
Our Services
Public Insurance Adjuster
Loss Consultants
Appraisal / Umpire
Pre Loss Consultation
Yearly Policy Review
Resources
The FIRM
How To File A Claim
American Policyholder Association
State Specific
Talk To An Attorney
Meet The Team
Contact Us
Contents Claim
Initial Claim Questionnaire
(844) 772-4872
team@psadjusting.com
HQ: 334 W. 806 N. Valparaiso, IN 46385
Please enable JavaScript in your browser to complete this form.
Policy Information:
Name 1
*
Name 2
*
Email
*
Home Phone
*
Cell Phone
*
Can we text you?
*
Can we text you?
Yes
No
N/A
Claim Address
*
City
*
State
*
Zip code
*
Is the Claim address the Same as Mailing Address?
*
Is the Claim address the Same as Mailing Address?
Yes
No
Mailing Address
Mailing City
Mailing State
Mailing Zip code
Insurance Information:
Insurance Information:
*
Policy Number
*
Claim Number
*
Mortgage Information:
Mortgage Company
*
Loan Number
*
Is the home for sale
*
Is the home for sale?*
Yes
No
N/A
Unknown
Are you currently refinancing?
*
Are you currently refinancing?
Yes
No
N/A
Unknown
Building Information:
Is this your primary residence or rental?
*
Is this your primary residence or rental?*
Primary
Rental
Please list the number of residents in this house.
*
Usage
*
Year Built
*
Year Purchased
*
Square footage of Building
*
Has the home had Home Inspections?
*
Has the home had Home Inspections?*
Yes
No
N/A
Unknown
Any Issues? (Please list them here)
*
Number of stories:
*
Easy access to property
*
Easy access to property*
Yes
No
N/A
Unknown
Additional information (copy)
Claim Information:
Were you home when the claim occurred?
*
Were you home when the claim occurred?*
Yes
No
N/A
Unknown
Additional information
Do you have photos or videos of the claim?
*
Do you have photos or videos of the claim?*
Yes
No
N/A
Unknown
if not, how long were you away?
Do you have prior claims on the property?
*
Do you have prior claims on the property?*
Yes
No
N/A
Unknown
Additional information
Closed / Paid / Repaired?
*
Closed / Paid / Repaired?*
Yes
No
N/A
Unknown
Additional information
Fire Investigation:
*
Fire Investigation:*
Yes
No
N/A
Unknown
Additional information
Water Damage:
*
Water Damage:*
Yes
No
N/A
Unknown
Additional information
Boarded Up:
*
Boarded Up:*
Yes
No
N/A
Unknown
Additional information
Preferred Vendor:
*
Preferred Vendor:*
Yes
No
N/A
Unknown
Additional information
Packout:
*
Packout:*
Yes
No
N/A
Unknown
Additional information
Items Removed:
*
Items Removed:*
Yes
No
N/A
Unknown
Additional information
Salvageable Clothing:
*
Salvageable Clothing:*
Yes
No
N/A
Unknown
Additional information
Injuries or Hospitalization:
*
Injuries or Hospitalization:*
Yes
No
N/A
Unknown
Additional information
Pets / Boarding:
*
Pets / Boarding:*
Yes
No
N/A
Unknown
Additional information
Bird(s) #:
Cat(s) #:
Dog(s) #:
Other(s) #:
ALE Information:
Out of Pocket Expenses:*
*
Out of Pocket Expenses:*
Yes
No
N/A
Unknown
Additional information
Advancement Payments:
*
Advancement Payments:*
Yes
No
N/A
Unknown
Additional information
Contractor Information:
Do you have a contractor?
*
Do you have a contractor?*
Yes
No
N/A
Unknown
Contractor information
Submit
