Pay Per Claim 2026

Pay Per Claim

Residential Only (3-5 Day Turnaround)
Company Name*
Your Name?*

First NameLast Name
Your Email Address*
This will be used on Xactimate
Best Contact Number*

Area CodePhone Number
Pay Per Claim - Supplement Claim Management ($250)Xactimate Supplement Write Service - Write Supplement against carrier scope and return to contractor ($250)Xactimate Estimate Write Service - Write estimate based on photos and satellite report and return to contractor ($150)
- Homeowner's Name*
  
  First NameLast Name
- What's the property address?*
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Roofing (pitched)Flat RoofRemove and Replace GutterDetach and Reset GutterRemove and Replace Gutter GuardDetach and Reset Gutter GuardSolar PanelsWindow ScreensSidingSoffitFasciaPatio PanelsMetal Roof
- Roofing (pitched)Flat RoofRemove and Replace GutterDetach and Reset GutterRemove and Replace Gutter GuardDetach and Reset Gutter GuardSolar PanelsWindow ScreensSidingSoffitFasciaPatio PanelsMetal RoofInterior
- Gutter LF*
  Provide Size in Job Detail Section
- Gutter Guard LF*
  Provide Quality in Job Detail Section
- Solar Panel Qty*
- Window Screen Qty*
  Provide Sizes in Job Detail Section
- Fascia LF*
  Provide Size in Job Detail Section
- Soffit SF*
  Provide Type in Job Detail Section
- Job Details/Roof Accessory Info/Etc.*
  Please provide details for context of the work being performed. We only know what you tell us :)
- Do You Want To Add 20% for Overhead & Profit?*
- Required Documents
  
  Photos
  Satellite Report (Roof / Siding)
  Roof Accessory Count (you can include in job details)
  Carrier Scope of Loss (if applicable)
- Link to Documents*
- *
  prevnext( X )
  
  Pay Per Claim - $250 + 10% of Success Fee
  $250 engagement fee + 10% success fee.   Comprehensive Pay-Per-Claim support including estimate evaluation, supplement development, documentation organization, carrier submission, follow-ups, rebuttals, and reinspection coordination
  
  $250.00
  
  
  
  Xactimate Estimate Write Service
  Produce Residential Xactimate Estimate based on photos and satellite report and return to contractor.
  
  $150.00
  
  
  
  Xactimate Supplement Write Service
  Produce Residential Xactimate Supplement based on carrier scope of loss photos and satellite report and return to contractor.
  
  $250.00
  
  
  
  Total
  
  $0.00
- PAY-PER-CLAIM PAYMENT AUTHORIZATION & SERVICE TERMS PAS Claims — Pay-Per-Claim Service Agreement & Payment Authorization
  
  By submitting a Pay-Per-Claim order with PAS Claims, you acknowledge and agree to the following terms regarding service delivery, fees, and payment processing.
  
  1. Service Overview This service provides professional claim support on a per-file basis and includes:
  - Estimate audit and accuracy review
  - Supplement development including missing line items and F9 notes
  - Photo and documentation organization
  - Supplement submission to the carrier
  - Carrier follow-ups, responses, and rebuttals
  - Reinspection coordination when applicable
  - Status updates throughout the process
  This is a per-file service, separate from the PAS Claims monthly Claim Management Program.
  
  2. Engagement Fee — $250 A non-refundable $250 engagement fee is required to begin work on each file. This fee covers file intake, estimate review and analysis, supplement preparation, documentation organization, and initial carrier submission.
  
  This fee is separate from and in addition to the success fee. It is not credited toward any other charges.
  
  3. Success Fee — 10% Upon approval of a supplement increase, PAS Claims will charge a success fee of 10% of the approved supplement increase amount.
  
  Example: Approved supplement increase: $3,000 Success fee (10%): $300 Total charges: $250 engagement fee + $300 success fee = $550
  
  4. Payment Authorization By completing the $250 engagement fee payment, you authorize PAS Claims to:
  
  Charge the card on file for the 10% success fee once your supplement approval has been finalized
  Process all future fees and payments associated with this claim to the same card on file
  No additional authorization will be required for the success fee charge
  A receipt will be emailed for every transaction
  If the card on file is declined, processing of the claim may pause until payment is resolved.
  
  5. Client Responsibilities To avoid delays in processing, you agree to provide accurate and complete information including photos, job details, carrier estimate and documentation, and adjuster contact information where applicable. Missing or incomplete documentation may delay the supplement approval timeline.
  
  6. Non-Refundable Terms The $250 engagement fee is non-refundable once PAS Claims begins work on your file. The success fee is only charged upon an approved supplement increase.
  
  7. Xactimate Write Services If submitting for a Xactimate Write Service, the applicable flat fee ($250 for Supplement Write or $150 for Estimate Write) is charged at the time of submission. These fees are non-refundable once work has begun. No success fee applies to write services.
  
  8. Acknowledgment By proceeding with payment and submitting this order, you confirm that you have read, understand, and agree to the terms above, including the $250 non-refundable engagement fee, the 10% success fee on approved supplement increases, and the authorization for PAS Claims to charge all fees to the card on file without additional authorization.
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