Form - Submit Claim Information

Submit Claim Information

We understand the importance of protecting your home and appreciate your interest in our no-money out-of-pocket SMART-TARP Shrink-Wrap Roof Protection Program. We want to make the process as easy as possible for you; kindly fill out the form below with all the requested information. We will review your submission and get back to you within the next 24 hours. Thank you for your time, and we look forward to speaking with you soon.

"*" indicates required fields

First Name of Insured 1*

Last Name of Insured 1*

First Name of Insured 2

Last Name of Insured 2

Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone Number Insured 1*

Phone Number Insured 2

Insurance Company Name*

Policy #*

Claim #*

Date of Loss*

Type of Loss*

Driver License

Upload a photo image of each driver's license that is listed on the declaration page.

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

Declaration Page

Upload a photo image or PDF of the Declaration page (that was in effect DURING the date of loss) of your policy (usually the very first page of the policy).

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 256 MB.

How Did You Find Us?*

Please let us know how you found us.

Name of Sales Person*

If you do not remember the name of the sales person just put, NA

Attorney: Name of Contact

Attorney: Law Firm Name

Attorney: Phone

Public Adjuster: Name of Contact

Public Adjuster: Company Name

Public Adjuster: Phone Number

Insurance Adjuster: Name of Contact

Insurance Adjuster: Phone Number

Comments / Notes:

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