Name:                            


Email Address:                   


Phone Number:                    


Address:                         




I am a (I work for):             Property Owner Property Manager Realtor Lender CPA Contractor Appraiser Friend/Family of Disaster Victim Public Disaster Relief Agency Private Disaster Relief Agency Other 


Whose property has been damaged: Mine My Client's My Friend's My Family Member's Other 


What type of damage has occurred:Earthquake Fire Flood Hurricane Tornado Hailstorm Rainstorm Windstorm Burglary Other 


Has a claim been made?           Yes No Don't know Not sure 


If a claim has been made

what was the approximate date:   


Was the claim denied?            Yes No Don't know Not sure 

If the claim was denied:         The claim was denied orally The claim was denied verbally 

Has a settlement been made?      Yes No Don't know Not sure 


Have repairs been completed?     Yes Not Begun Begun but not completed Don't know Not sure 


How do you feel about how you are being/have been treated?

the claim seems to be being processed fairly. (Read the story under Friends & Family) we feel we are being treated unfairly. we are angry & frustrated and think we're being lied to, cheated and ripped off! we are not sure 


Would you like to receive email notices about important

changes or deadlines pertaining to property insurance? Yes No