WE ARE YOUR PROPERTY DAMAGE LAW FIRM

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for choosing Law Offices of Scott Klotzman, P.A. to support you through the property damage insurance claim process. We strive to produce outstanding results while expediting your claim in a timely manner.
DIRECTIONS: Please fill out our client information form below, to the best of your ability.
Once received, our office will review and connect. Expect to sign a retainer so you can secure our services and we can begin to expedite your claim. Remember, claim reviews are free and we only collect if you do. If you have any immediate questions, please do not hesitate to email us at help@scottklotzman.com or by phone at 954-807-3959 or toll free at 1-877-321-PDLF

Full Name *

Property Address *

Phone Number *

Email Address *

Insurance Company: *

Full Name of any additional Insured(s) Listed on Policy

Policy Number: *

Is there a Mortgage listed on the Policy? *

Yes

Cause of Loss *

Hurricane & Windstrom

Water & Fire Damge

Mold Growth

Burglary & Vandalism

Business Interruption

Other:

Date of Loss: *

YYYY

Please give a brief description your matter? *

Was your Insurance Company notified? *

Yes

Claim Number:

Did your Insurance Carrier request any of the below?

Proof of Loss

Appraisal

Examination under oath?

Recorded Statements?

Other:

Clear selection

What is the Current Response from the Carrier? *

Partial Payment Made

Fully Denied Claim

No Response from Carrier

Further Investigation Needed

Other:

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms