Submit a Claim Need to submit a claim fill out this form Adjuster Name* First Last Adjuster Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Adjuster Email* Adjuster Phone Number* Claim Number* Date of Loss* MM slash DD slash YYYY Loss Type*Please selectHailHigh Voltage SurgeLightningSmoke / FireTheft / VandalismUnknownWaterWear & TearWindForeign Object ImpactProperty TypeResidentialCommercialInsured Name* First Last Insured Company Name (If Applicable) Insured Phone Number* Loss Location* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Loss Description / Special InstructionsAttach FilesAccepted file types: doc, docx, pdf, jpg, xls, gif, jpeg, bmp, tiff, xlsx, Max. file size: 128 MB.Attach FilesAccepted file types: doc, docx, pdf, jpg, xls, gif, jpeg, bmp, tiff, xlsx, Max. file size: 128 MB.Attach FilesAccepted file types: doc, docx, pdf, jpg, xls, gif, jpeg, bmp, tiff, xlsx, Max. file size: 128 MB.Attach FilesAccepted file types: doc, docx, pdf, jpg, xls, gif, jpeg, bmp, tiff, xlsx, Max. file size: 128 MB.Attach FilesAccepted file types: doc, docx, pdf, jpg, xls, gif, jpeg, bmp, tiff, xlsx, Max. file size: 128 MB.