Arizona Claim Service LLC

CLAIM REGISTRATION Please enter your information

*Indicates Response Required        ? Click on for Help with the field

Your Name

Your Current Address

Is it allright to communicate with you via email? *

Move Information

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Were Your Items Stored?
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What Valuation did you select? 
If you chose Option B (FVP) what is your Deductible?
Did You Purchase Additional Insurance?

LIST OF DAMAGED ITEMS Enter the Lost or Damaged Items Below

UPLOAD PICTURES OF DAMAGED ITEMS

You may upload pictures of the damaged items here.  Please ZIP your pictures and enter that file name here.
Maximium size of the file is 20 Megabytes

 

To print a copy:  make sure you have selected Landscape in File/Page Setup > then select File/Print


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