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Client Intake Form SMS Consent Disclaimer

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Claim Titan Form

Primary Insured Information

First Name or Business Name

Last Name

Phone

Street Address

City

Zipcode

State

Mailing address different from loss location?

Mailing Address Street Mailing address if different than loss location.

Mailing City Mailing city if different than loss location.

Mailing State Mailing state if different than loss location.

Mailing Zip Mailing zip code if different than the loss location.

Is there a Co-Insured?

Co-Insured First Name Co-Insured First Name

Co-Insured Last Name Co-Insured Last Name

Co-Insured Phone Co-Insured Phone

Co-Insured Email Co-Insured Email

Insurer Information

Insurance Provider Name

Claim Information

Do you have a claim number?

Claim Number (if you have one)

Cause of Loss

Claim Type Is this a new claim or a supplement?

Date Loss Occurred

Loss Description Describe the damages and the cause.

Upload Your Policy and Documents

Upload Claim Files

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Thank you for submitting your claim! We have received your information and will review your claim within the next 24 to 72 hours. We will get back to you as soon as we have reviewed your claim. Thank you for choosing us.