The Gold Standard in California Public Adjusting
Please complete this short survey so we can evaluate your claim and provide you with the best possible assistance.
Today's Date
What is your Name?
First Name
Last Name
Phone Number
Email Address
How did you find us? Please select an optionGoogle/Online SearchReferralPodcastAdvertisementOther
What best describes the property type?
Primary Residence Primary Residence
Rental Property Rental Property
Commercial Commercial
Condominium Condominium
What is your role in this property?
Owner
Renter
Business Owner
Other
When did the loss occur?
Type of loss the property sustained? (select 1 or more)
FireWater DamageWindstorm & RainTree FallRoof CollapseFloodTheft and/or vandalismEarthquake
Describe the loss and the damage(s) to the property
Total Square Feet
Damaged: 0%-100% 0%
Estimate/Payment $
Total # of Floors Please select1 Story2 Story3 Story4 Story
List all rooms
Mortgage? Please selectYesNoUnsure
Insurance Co.
Current Situation (1-8) Please select1.Have not done anything2.Submitted a claim & waiting3.Mitigated Damages4.Waiting for Insurance estimate5.Received Insurance estimate6.Ready to hire a contractor7.Have insurance & contractor estimate8.Beginning repairs
Desk Adjuster handling your claim
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2
3
4
5
Upload your Insurance Policy and/or declarations page
Insurance Policy
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