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Claim Filing Information

Is this for a NEW claim? *

YES (It is a new "un-denied" claim)

NO (Claim has been denied in full or in part)

Insured's Information

Named Insured(s) / Company, Church, Org., Etc. *

Primary Contact *

Primary Phone *

Primary Email *

Loss Location - Street Address *

Loss Location - City *

Loss Location - State *

Loss Location - Zip Code *

Claim Information

Carrier Name *

Policy Number *

Type of Building *

Type of Loss *

Is This a Referral from a Fat Ox Certified Contractor? *

YES

NO

Brief description of claim (What's damaged?) *

DEC Page and/or Policy *

Please upload a PDF or Image of the DEC Page/Policy

Photo Report (PDF / or 20 images max)

Please upload overviews and upclose images of the damage

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Course Creator 360

claims@bigfatox.com

833 - 244 - 3286