Claim Submission - Premier Claims

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Post Title

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Post

Property Owner Contact Information

Name*

First Last

Phone*

Email*

Include company name or business entity as property owner?

Yes

No

Business Name

Include contractor's information?*

Yes

No

Contractor Contact Information

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Contractor Contact Information

Contractor Name*

First Last

Contractor Company

Contractor Phone*

Contractor Email*

Property & Damage Information

Property Address*

Street Address Address Line 2 City State ZIP Code

Property Type

When did the damage occur to the property?*

Who is the insurance carrier?

What is the policy number?

Has there been a claim already filed?

Yes

No

Documents & Photos

Do you have policy or claim documents to upload?

Yes

No

Upload Documents

Drop files here or

Max. file size: 256 MB.

Do you have photos of damage you'd like to upload?

You may upload picture files or insert a link to a picture folder.

Yes

No

Upload Damage Photos

Drop files here or

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

Photo Link

Provide a public share link for our team to review.

Copy of Agreement

Yes, I will review your service agreement.

Are you working with a Premier Claims representative?

Please include additional notes or questions for our team