Single Wildfire Loss Claim Form

Single Wildfire Claim

Adjuster's Name(Required)
Independent Adjuster's Name
Subrogation Adjuster's Name
Are damages for economic loss only?
MM slash DD slash YYYY
Status of Adjustment(Required)
Enter exact address or latitude and longitude, if possible.
If unknown, please type "Unknown".
Is this Claim Solely for Smoke/Ash Damage?
Drop files here or
Accepted file types: jpg, png, pdf, doc, xlsx, Max. file size: 50 MB.
    Multiple files can be uploaded. Zip files not supported.