Internal Intake Form

ClaimsMate is a Public Adjuster firm providing assistance for property damage insurance claims.

Public Adjusters are state licensed insurance claim professionals that help determine insurance policy coverage, inspect and estimate damages, and help property owners obtain a fair claim settlement from their insurance company.

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Begin call script:

Can I ask who I'm speaking with today?

First Last

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Thank you , are you calling about a residential or commercial insurance claim?

Commercial - My business
Residential - My home
My automobile
My boat
My RV/Motorhome
My Farm/Crops
Not calling about a claim

Unfortunately, we do not handle auto insurance claims and don’t know of any firm that does. I apologize that we can’t be of more assistance to you today.

I’m so sorry to hear about your (loss / issues with your insurance company). I’d like to gather a little more information to see if one of our public adjusters can help you with your claim.

Any Other Claim Type:

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What is the zip code where the property is located?*

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I'm sorry I'm not able to find the city and state using this zip code. Could you please tell me what City and State this is in?

City State

Any Other Areas Damaged:

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Great thank you, . Do you have any idea how much it would cost to make repairs? It doesn’t have to be exact, but your best guess will help us determine the best options to help with your claim.

Less than $10,000
$10,000 - $25,000
$25,000 - $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 or more
I'm not sure

Do you know the exact date of loss? If not, an approximate date will work

Are there any other specific questions or concerns you would like to include about your claim?

Add any relevant notes from the caller about the claim

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Message Details

Enter the callers message below

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Thank you for taking the time today and I am sorry you are going through this. Let me make sure I have your correct contact information and I will get this request sent out right away for you.

Thank you. Let me make sure I have your correct contact information and I will get this request sent out for you.

First Name:

Last Name:

What's a good e-mail address we can reach you at:*

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And a phone number to reach you?:*

Phone format: ### ###-####
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And the best hours to reach you:

We normally send out an email alert to first contact you, please check in your spam folder, just in case you don't see it in your inbox.