Storm Damage Claim Form (This does not file a claim with your insurance carrier. It notifies our agency so we can contact you and guide you on next steps.) Name(Required) First Last Full Property Address(Required)Street Address, City, State, Zip Cell Phone Number(Required) Email(Required) Enter Email Confirm Email Loss Description(Required)The more detail you can provide the better.Damage Level Severe | Home is unlivable (roof damage, structural issue, major flooding). Requires immediate callback Moderate | Significant but not catastrophic damage (partial roof damage, broken windows, tree on property but not on the house). Minor | Minor damage (downed fence, lost shingles, basement seepage). Date Damage Occurred or Noticed(Required) MM slash DD slash YYYY Policy Number(Required) Was any Repair or Clean-Up Company called?(Required)YesNoPhotos of Damage (if available) (file upload, optional)Max. file size: 5 MB. Date MM slash DD slash YYYY Date MM slash DD slash YYYY
