Hire StormPro

Type of Claim

Type of Claim(Required)

Emergency

Non-Emergency

Reopened

Supplemental

Policyholders

How many policyholders are listed on the declarations page?(Required)

Policyholder 1 Name(Required)

First Last

Policyholder 1 Mailing Address(Required)

Address City State ZIP Code

Policyholder 1 Phone(Required)

Policyholder 1 Email(Required)

Policyholder 2 Name(Required)

First Last

Policyholder 2 Mailing Address(Required)

Same as Policyholder 1

Address City State ZIP Code

Policyholder 2 Phone(Required)

Policyholder 2 Email(Required)

Policyholder 3 Name(Required)

First Last

Policyholder 3 Mailing Address(Required)

Same as Policyholder 1

Address City State ZIP Code

Policyholder 3 Phone(Required)

Policyholder 3 Email(Required)

Policyholder 4 Name(Required)

First Last

Policyholder 4 Mailing Address(Required)

Same as Policyholder 1

Address City State ZIP Code

Policyholder 4 Phone(Required)

Policyholder 4 Email(Required)

Loss Information

Date of Loss(Required)

Brief Description of Loss(Required)

Address of Loss(Required)

Same as Policyholder 1 Mailing Address

Street Address City State ZIP Code

Name of Insurance Company(Required)

Policy Number(Required)

Claim Number(Required)

Name of Mortgage Company(Required)

If inapplicable, type N/A

Loan Number(Required)

If inapplicable, type N/A

property is insured under other insurance policies

Check this box if property is insured under other insurance policies

Other Insurance Policies(Required)

Click the plus and minus buttons on the right to add or remove insurance companies

Company

Policy Number

Claim Number

Others with an Interest in the Property(Required)

If inapplicable, type N/A

Legal Representation

represented by an attorney

Check this box if you have legal representation

Name of Attorney(Required)

Phone(Required)

Email(Required)

Address(Required)

Street Address City State ZIP Code

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