R2R Intake Form
Please use this form to submit any claim related questions you have for our upcoming webinar. Thank you for taking the time to complete this form.
* Required
Your full name
*
Your answer
Your email address
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Your answer
Please indicate your insurance problem (choose all that apply)
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claim denial
communication delays
Examination Under Oath (EUO)
excessive depreciation
insufficient ALE
lowball estimates
mortgage issue
multiple adjusters
payment delays
underinsurance
other
Please state your claim-related question here. We will do our best to provide a response during the webinar.
*
Your answer
Name of your insurance company
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Your answer
Please indicate the fire that affected your home
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2018 Camp Fire
2018 Woolsey Fire
2019 Kincade Fire
Other wildfire
If you selected "Other wildfire," please tell us the name of your wildfire.
Your answer
If you're willing to talk to the media about your insurance problem, please share your phone number.
Your answer
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