Customer Onboarding for Flood Restoration Service

Customer Onboarding for Flood Restoration Service

Please provide your key information for billing, job location, and contact details. Additionally, inform us about your insurance coverage.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Job Location Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Do you have flood insurance coverage?*

YesNo
Provide you insurance policy number.*
By submitting this form and engaging Local Carpet Cleaning Pty Ltd and Premier Restorations Group Pty Ltd for flood restoration services, you acknowledge and agree that:
1. You are solely responsible for payment of all invoices for services rendered, in accordance with the agreed terms and progress stages.
2. It is your responsibility to file any insurance claims related to the flood damage and to seek reimbursement from your insurer.
3. Local Carpet Cleaning Pty Ltd and Premier Restorations Group Pty Ltd will not submit claims on your behalf or make payment contingent on your insurance approval.
4. You confirm that any insurance policy details provided are for reference only and do not alter your payment obligations.
Should be Empty: