Insurance Claim Request

We kindly ask you to fill this in and attach an invoice (in case of repairs always attach an estimate of costs)
and a photo of the damage.

    First Name *

    Last Name *

    Your Email Address *

    Contact Number *

    Job Id *

    Cleaner's First Name *

    Cleaner's Last Name *

    Date of cleaning (MM/DD/YYYY) *

    What was damaged? *

    How old is the damaged object? *

    What was the original price of the damaged object? *


    Please describe in details what was damaged and how. *

    What are the expected costs for a replacement or a repair of the damaged object? *


    (* = required)