Submit a Claim admin 2017-05-18T19:27:34+00:00

Submit a Claim

To submit a claim, please completely fill out the form, and a FRSTeam representative will contact you.

Claim Information
Name of Person Reporting Claim
First Last
Phone Number
Type of Loss
Insured Name(s)
Claim/Reference Number

Loss Site
Address
Street Address Address Line 2 City State ZIP Code
Insured Contact Numbers
Home Phone Number
Work Phone Number
Cell Phone Number
Email

Authorized Items and Instructions
Item Types
- Clothing
- Bedding
- Window Treatments
- Specialty Items
Please List
Onsite Special Instructions
Hold for Bill Approval*
- Yes
- No

Billing Information
Company Name
Address
Street Address Address Line 2 City State ZIP Code
Phone Number
Fax Number
Adjuster/Contact
Email

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