Hire Home Safe Claims

Client Information

Named Insured

Additional Insured

Email Address

Phone No. (main)

Phone No. (other)

Property Details

Address

Address 2

City

State

Zip

Claim Details

Insurance Company

Policy Number

Claim Type

Original Claim No.

Claim Denied?

Yes

Payment Received?

Yes

Type of Loss

Date of Loss

Policy Has 10K Limit?

Yes

Damaged Areas

Public Adjuster

Claims Adjuster

Fee

Signatures

Enter Named Insured

Enter Additional Insured

Today's Date

Services

Please indicate if the following services are needed:

Water Mitigation

Yes

Plumber

Yes

1401 N University Dr, Suite 502, Coral Springs FL 33071

Attention hours
8:30 am. to 5 pm.

Eduardo Rodríguez Delgado
/P090488
Rodrigo Yervis
/W470007
info@homesafeclaims.com

1-800-948-2849