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)