Insurance Claim Assistance Request -

Insurance Claim Assistance Request

This form helps us understand your insurance claim needs so we can provide the best possible assistance. Please fill it out to start the process of getting support with your claim.

Client Information:

Full Name

Address

Phone Number

Property Information:

Property Address

Type of Property

Insurance Information:

Insurance Company Name:

Policy Number

Claim Number (if already filed)

Date of Loss/Incident

Type of Loss/Incident

Description of Damage:

Please provide a brief description of the damage to your property

Requested Assistance

Please indicate the type of insurance claim assistance you require

Requested Assistance:

Initial Consultation/Claim Review Documentation Assistance (gathering photos, estimates, etc.) Communication with Insurance Adjuster Review of Insurance Estimates/Settlements Other

Authorization:

I authorize Trail Glaziers, LLC to communicate with my insurance company regarding this claim and to provide assistance as requested above.

This information is for informational purposes only. Trail Glaziers, LLC will provide assistance to facilitate the insurance claim process. However, we cannot guarantee the outcome of your claim. This request does not constitute a contract for restoration services. A separate contract will be provided for your review and signature if you choose to hire Trail Glaziers, LLC for the repair work.

Insurance Claim Assistance Request

Services

Contact Info