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FILL OUT THE FORM BELOW AND SUBMIT

Claim Filing Information

Is this a NEW claim?

YES (There has been no carrier involvement yet)

NO (We need help with an existing claim)

Insured's Information

Note: Spelling must match the policy/claim documentation.

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 (Not the Claim Number) *

Type of Building *

Type of Loss *

Contractor Information

Is there a contractor involved that needs to be updated?

YES

NO

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

DEC Page / Policy / Carrier Estimate / Etc...

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

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Course Creator 360

claims@bigfatox.com

833 - 244 - 3286