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HOME Insurance Simple & Easy Claim Form Wind Flood Quake Fire

2011 Insurance Information
Collection Form

Please answer these questions below and we will have an attorney or adjuster contact you with a follow up.

Name of Home Owner: *
Address Street 1:
Address Street 2:
City: *
Zip Code: *	(5 digits)
State: *
Email: *
Cellular Phone: *
Evening Phone:
When did your loss occur?: *
Are you being represented by an attorney or adjuster now?: *
What is the name of your insurance company?:*
Who is the representative from the insurance company & phone number?:: *
Comments about insurance coverage & service:	Enter comments here!
What is the CURRENT TAX VALUE of your home?:
What is your insurance deductible?:
What percentage of your home was affected by damage?:
Did you get LICENSED CONTRACTORS to give appraisals of repair to damage area?
How much are your contractors' estimates?::
Has the insurance made an offer to settle your claim?
How much has the insurance company offered to settle your claim?:
What is the DIFFERENCE between your estimates and the insurance estimates?:
	Please print this page for your records! Astericks must be answered!

Please know that you are not considered a client until your case has been accepted by an adjuster or attorney and you have signed a formal "retainer agreement."

Hindsight is an 'information collection service' located on Sanibel Island, Florida. Experience matters with LOSS CLAIMS & Insurance. We have been providing help to victims of Hurricane Katrina, Charley, Ivan, Dennis and Rita. CA earthquakes, AZ fires, PA floods, MN Tornados have also been serviced, and hundreds of other home / business insurance claims. Hindsight has agreed to keep all information confidential and will only disclose this information to a licensed attorney or adjuster in your state.
**Do not rely on the information in this site in lieu of consulting an attorney. This site will point you in the right direction. This site is not considered legal advice. (Communication through email is not a secure method of communication. If you email us, the firm reserves the right not to respond to inquiries. This communication does not create a contract or create any obligation on the part of the sender or the recipient.) Your confidential information will be referred to a state licensed Attorney or Public Adjuster.

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HOME Insurance Simple & Easy Claim Form Wind Flood Quake Fire