Fraternal Property Claims

"*" indicates required fields

Loss Information

MM slash DD slash YYYY
(i.e. wind, hail, theft, etc.)

Main Contact Information

Name*

Secondary Contact Information

Name
Which contact will provide access to the house?
Was this reported to the Police Department?
Was this reported to the Fire Department?
Were emergency repairs required?
If yes, provide the contractor information below
Do you have a contractor selected to complete the repairs?
Contact Name
Name of person completing report
MM slash DD slash YYYY
Drop files here or
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    Upload pictures, invoices, etc.