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TELL US ABOUT YOUR CLAIM
Name
Contact Info
Insurance Company/Carrier
Policy #
Address of Loss
Date of Loss
*
required
Do you REQUIRE Emergency Property Services?
Do you require emergency property services?
Is the property livable/useable?
Is the property livable/usable?
Cause of Loss
Cause of Damage
Description of Loss
I understand that this form alerts Dees Insurance Group of a possible claim, so they can help me with the claims process. Completing this form does not file a claim directly with any carrier.
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