Request a Free Claims Evaluation

Policy Holder's First and Last Name*

Property Address, City, State and Zip Code*

Policy Holder's Phone Number*

Policy Holder's Email Address*

Property Type*

Name of Property or Business*

Date of Loss*

Type of Loss*

Cause of the damage(s)*

Severity of Damage*

Did you file a claim? If so, when?*

Was your claim denied?*

Name of Insurance Company*

Insurance Company's Phone Number?*

Policy Number*

Claim Number*

Adjuster's Name, Phone Number and Email Address*

Was a field adjuster sent out by your insurer? If so, when?*

Have you received an estimated cost(s) of damage(s) from your insurer?**

Has payment been made on any part of the claim?*

Was damage that caused loss repaired/mitigated?*

Name, address and phone number of repair/mitigation company?*

Has contractor estimates been provided? List contractor information*

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Dena Corbin, LPIA
TX Licensed Public Insurance Adjuster
TX Lic: #2504045