C & M

The Insured understands that this document must be signed prior to the PA initiating any contact with the insured's insurer, the insurer's adjuster, or the insurer's attorney regarding settlement of the insured's claim. This document will serve as a notification letter signed by the insured confirming that the insured has authorized the PA to communicate directly with the insurer, the insurer's adjuster, or the insurer's attorney on behalf of the insured. The public adjuster has no direct or indirect interest in the claim to be adjusted except for the consideration for public adjuster services. The insured represents that all information given to the PA is true and accurate. The insured understands that the PA relies on the information provided by the insured. C & M Claim Consultants guarantees to be fully licensed and insured, and that the license number listed below is valid and in full force and effect as of the date the contract is signed.

-WE RESPRESENT THE INSURED ONLY-

Name

Phone Number

Insured Email

example@example.com

Street Address

Date

Date of LossDiscovery

Date

Loss Description

Insurance Carrier

Policy Number

Claim Number

Insured Signature

C & M Claim Consultants receives no direct or indirect compensation from any entities that may be involved in this claim, nor is involved in any aspect of the reconstruction or repair of any claims.