Claim Submitted

Thank you. A member of our team will review your submission and contact you, usually within one business day.

1

Your Info

2

Loss Details

3

Insurance

4

Review

Person Completing Form

Who is submitting this claim today?

01

Full Name *

Policyholder Information

Primary insured on the policy

02

First Name *

Last Name *

Phone Number *

Email Address *

Policyholder 2 Optional

If there is a co-owner or second insured

03

First Name

Last Name

Phone Number

Email Address

Contractor Information Optional

If a contractor is involved in this claim

04

First Name

Last Name

Phone Number

Loss Details

Tell us what happened to your property

05

Date of Loss *

Loss Type *

Property Loss Address *

Brief Description of Loss *

Insurance Information

Details about your current insurance claim

06

Insurance Company *

Policy Number Optional

Claim Number Optional

Claim Status

Anything else we should know? Optional

Your Adjuster

Select the adjuster handling your claim

07

Assigned Adjuster *

I agree that Nations Public Adjusting may contact me by phone, text or email about this claim. Submitting this form does not hire Nations Public Adjusting or create a public adjuster contract.

No upfront cost. No obligation.
A member of our team will contact you, usually within one business day. Your information is used only to review your claim.

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Licensed Adjusters

Fast Response

No Upfront Cost

Nations Public Adjusting, Inc. | FL Lic. P169123
417 5th Ave, Suite 206E, Indialantic, FL 32903
321-508-6246 | tonyruggiano@gmail.com

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