Property Claim Form

Property Claim Form

-   The "ENTER" or "RETURN" Key will submit the application.   Use the "TAB" Key and Mouse to navigate.
      If application is submitted by mistake, use the "BACK" Button on your browser to return to the application.

-  This form is intended for your "owned" Property Claims. If your claim involves Property Damage to
    other's property you do not own, use the General Liability Claim Form.

Your Account Name:		Phone: Type: Cell Business Home
City, State	State:	Fax:
Person Completing Form:		Email:

WHO IS TO BE LEAD CONTACT FOR FURTHER INVESTIGATION OR CLAIM INFORMATION SAME AS ABOVE

Lead Contact Name: Phone #:Cell Business Home Email:

CLAIM INFORMATION

Date of Claim Occurrence: Time of Claim Occurrence: AM PM

Location of the Claim (address, city, state, zip or specific area):

Description of Loss and Damage that Occurred?

If an authority such as police or was contacted, please name:
What is the report # of the authority, if known:

PROPERTY DAMAGED INFORMATION

What kind of loss occured? Fire Theft Lightning Hail Wind Storm Water Vandalism   Other:
If applicable, have you secured the damaged property to mitigate further damage?   Yes   No
   If NO, please do so and keep all receipts for items / services purchased.

Do NOT throw away damaged item(s). Keep them in a secure place as the company may need to investigate or view item(s)
.

AMOUNT OF DAMAGES

Estimate Amount of Damages ($ Amount): or Unknown Estimate is in Process of being completed

!!! IMPORTANT !!!
Hold supporting documents (pictures, receipts, etc) as your insurance company adjuster will request them if needed.

QUESTIONS / HELP
Office Email:	insurance@thompsongusic.com
Office Phone:	(412) 271-8888 (9 - 4:30 EST)
Office Fax:	(877) 271-8898