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New Claim Request

Adjuster's Name

Adjuster's Email

Insured's First Name

Insured's Last Name

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Additional address with the same claim number

Claim number

Operating Insurance Company

Loss Type(s)

Hail

Wind

Water

Tree

Fire

Flood

SIU

Animal

Other(enter below)

Other loss type

Contractor/PA

Service Type(s)

Roof Inspection

Siding Inspection

Inspect All Structures

Order Measurements (if damage is found)

Interior Inspection

ITEL Sample

Remove And Reset Tarp

Emergency Tarp

In-person Adjuster Training

Estimate

Supplement

Claim Desk Review

Measurements Only

Additional Notes

UPLOAD LOSS NOTICE (and/or other documents involved with this claim - Dec. Page if requesting estimate)

Upload File

Additional File

Upload supported file (Max 15MB)

Additional File

Upload supported file (Max 15MB)

Additional File

Upload supported file (Max 15MB)

Additional File

Upload supported file (Max 15MB)

Photo File

Thank you for your request!

This claim is now visible in your portal.

https://safeclaim.bluefolder.com/portal/login.aspx

Portal Login

claims@safeclaimconsulting.com

9204220069

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