Submit New Utility Claim Form
Claim Details
Claim Number
Date Of Loss
Claim Cost
Contact Person
Contact Phone
Contact Email
Insured Name
Description
Claimant Information
Claimant Name
Claimant Address
Claimant Contact
Claimant Phone
Claimant Email
Please attach all necessary files below
Claim Attachment 1
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Claim Attachment 2
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Claim Attachment 3
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Claim Attachment 4
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Claim Attachment 5
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Please inform this office of any activity concerning this claim.
We have accepted this assignment on a contingent basis and will full settlement authority. Our consultant/settlement fee will be 50% of the reduction in liability. Settlement of utilities damage claims can be compared to subrogation/recovery and may take an abnormal length of time to resolve.
I Have Read and Accept the terms above.
Create Utility Claim
