Our job begins
when the loss
occurs...
Email
notify@deckerclaims.com
General Information
973.258.9300
fax 973.258.1530
Emergency Hotline
973.258.9300
Submit Assignment
CLIENT INFORMATION
Submitted by: Full Name
Company
Assignment
Full Adjustment
Investigation
Formal Appraisal
Agreed Appraisal
Appraisal Only
Reinspection
INSURED INFORMATION
Cause of Loss
Date of Loss
Insured
Loss Location
Mailing Address
Contact Person
Relationship
Home Phone
Cell Phone
Business Phone
INSURANCE INFORMATION
Policy Number
Effective Date
Claim Number
Building
Coinsurance %
Personal Prop.
Coinsurance %
Other Insurance
Coinsurance %
Deductible
Forms
CLAIMANT INFORMATION
Claimant
Home Phone
Mailing Address
Cell Phone
Business Phone
COMMENTS / SPECIAL HANDLING
REPORT TO
Full Name
Title
Phone Number
Email
Agent
Agent Phone #
Address
Agent Email
