Electronic Catastrophe Assignment................................Rimkus Consulting Group, Inc.
Field Names in RED Are Required Fields.

Insurance Company:
Company Name:
Address:
City:
 State: Zip Code:
Email:
 Telephone: Fax:
Your Name:
 Cell No:
Claim Number:
 Policy Number:
Your Insured:
 Tel: Cell or Alt No:
Location of Occurrence:
City:
 State: Zip Code:
Date of Loss:
Description Of Loss:
Services Requested from Rimkus:
 (Please Check Box)
Site Visit Mechanical Inspection Structural Analysis
Please Describe Exactly what you want the engineer to determine:(description box)

Adjustment Company:
Address:
City:
 State: Zip Code:
Telephone:
 Adjuster: Cell No:
Email:
 File Number: Fax No:
Paperless report and invoice required?
Yes No

(If the yes box is checked an email address is required.)
.
Voice: 713-621-3550, 800-580-3228 | Fax: 713-623-4357 | Email: expert@rimkus.com
Copyright © 2003 RIMKUS Consulting Group, Inc., All Rights Reserved.

Catastrophe Hotline: (866) 408-4228 | Fax: (800) 228-2223 | Email: catclaims@rimkus.com