Storm 24 Inc.

Earthquake Damage Claims Application

Please complete the following form to have a Storm 24, Inc. consultant inspect your property free of charge.
For emergency assistance, call us toll free at 800-588-5135.

* Required Fields

Property Owner's First Name :

Property Owner's Last Name :

Company :

Property Owner's Address :

City :

State :

Zip :

Telephone :

* ext:

E-mail :

This information is held in strict confidence, and is used
solely for the purpose of reviewing your case. (see below)

Type of claim :

Name of Insurance Carrier :

Was Carrier Contacted :

Yes | No

Description of Damages :

This information is held in strict confidence, and is used solely for the purpose of reviewing your case. We restrict access to your confidential data to Storm 24, Inc. employees and staff who need to know the information to provide our services to you. We observe and maintain strict physical, electronic, and procedural safeguards to protect your information. We may collect and store information for statistical purposes in our own proprietary database. We will release information about you only if you direct us to do so in furtherance of your claim, if we are compelled by law to do so, or in other legally limited circumstances. We never sell, furnish or disseminate your information to any third party for any reason.

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"While we can't prevent it, we can get you through it!"

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