Claim Review Form
Please Include As Much Information As Possible So We Can Give It An Good Look
Company Name
*
Customer Name (Your Insured Customer)
*
First Name
Last Name
Customer Address (Your Insured Customer Address)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Claim Information
**IMPORTANT NOTE** Please remember to add photo gallery links and not individual links. If you are having trouble uploading anything please email to claims@vpablacklabel.com
Claim Type (Underpaid claims will either fall in new or reopen)
*
New, Not Filed
New, Already Filed
Reopen
Denied (Meaning zero payment; accompanied by a letter of denial)
Would you like a professional claim package created
*
Yes (I already have an account)
Yes (I need to be connected to a professional)
No, I will provide my own documentation
Upload Insurance Documentation
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Upload Estimate
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ESX or Lump Sum
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Add Link to Photo Gallery
Remember The More Detailed Photos The Better
Photo Upload
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Upload Weather Report
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Upload Code Report
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Upload Telemetry Report
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Please Upload Any Additional Supporting Docs
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Is The Property?
*
1 Story Residential
2 Story Residential
3 Story Residential
Commercial
What Is An Acceptable Amount For: Roof?
What Is An Acceptable Amount For: Exterior?
What Is An Acceptable Amount For: Interior?
Project Summary
*
Please provide a detailed summary of what needs to be done on this project.
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