Request Assignment
Attorney, Adjuster, etc. Company Information
Name
*
First Name
Last Name
Attorney, Adjuster, etc. Firm/Company Name
*
Phone Number
*
Format: (000) 000-0000.
Company Email
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Request Assignment
Insureds Information
Insured's Name
*
First Name
Last Name
If insured is a Business or Entity input name
Business or Entity name
Insured's Phone Number
*
Format: (000) 000-0000.
Property Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Desk estimate or Field estimate?
*
DESK ESTIMATE (You will provide pictures, floor plan, reports, measurements, etc.)
FIELD ESTIMATE (BCC representative will inspect property with a Company representative)
FIELD ESTIMATE (BCC representative will inspect the property with the Insured)
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Claim Information
What kind of claim?
*
Flood
Water Mit
Roof only
Cat 3 water loss
Rebuild/Reconstruction
Hurricane/Tornado/Natural Disaster
Fire/Smoke (Rebuild and/or Cleaning)
Appraisal
Other
Date Of Loss
*
-
Month
-
Day
Year
Date
Insurance Carrier
*
Claim Number
*
Policy Number
Deductible
*
Loss Type
Be specific on the loss type (i.e plumbing supply line, HVAC, etc)
Incurred Expenses/Receipts/Invoices to be included
Please include the company or store name and the total amount
Description of loss/ Damaged areas
The more detail provided the better/more quickly your estimate will come out
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Browse Files
For large files we recommend providing us a Dropbox link
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