Hail Assessment Form

Your Information

New or Changed Information

New Clients or New Information
New Clients or New Information
New Clients or New Information
New Clients or New Information
New Clients or New Information

Insured's Information


Assignment

mm/dd/yy

Equipment

Company & Address
If different from Insured's phone numbers

Answer ONLY if a UNITARY / GAS PACK SYSTEM


Report Submission


Name, Co., Address, Email and Telephone

Photos/Documents

You can upload up to 10 files or photos (individual file size is 3 Megs). If you need to upload more please fill out another form and note it in the NOTES section.