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Client Intake

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Client Intake Form

Name *

Company Name *If applicable

Phone *

Email

I Am A: *

Secondary Contact / Assistant

What Services Are You Looking For? *

Billing Contact

Billing Contact Phone #

Billing Contact Email

Project Name

Project Address

Property Contact Name

Property Contact Phone #

Property Contact Email

Date of Loss

Policy Date Range

Type of Loss

Roof Damage?

Yes

No

Unsure / Other

Interior Damage?

Yes

No

Unsure / Other

Exterior Damage?

Yes

No

Unsure / Other

Repairs Made?

Yes

No

Unsure / Other

Blueprints Available?

Yes

No

Unsure / Other

Roof Access? *If applicable

Yes

No

Unsure / Other

Roof Type *If applicable

Number of Buildings

Number of Stories

File Upload *PDF, JPEG, PNG, GIF, HEIC, ZIP, WORD Only

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