Damage Form
Oops we broke something. Please describe the accident below.Be sure to leave a handwritten Oops card.
What location
*
Please Select
Fargo
Grand Forks
Detroit Lakes
Was the damaged caused by us?
*
Yes
No
Unkown
Your Name
*
First Name
Last Name
Date it happened
*
-
Month
-
Day
Year
Date
Clients Name
*
Describe where in the home it was located.
*
Describe what happened in detail.
*
WHAT DID YOU BREAK? (BE DETAILED)
*
Any Brand, Make, Model or Serial Number to help us replace it?
*
Estimated Replacement Value
*
Photo(s) of item BE SURE TO TAKE PHOTO OF FULL ITEM INCASE WE NEED TO GOOGLE IMAGE SEARCH IT
*
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