The Chazz Pearce Law Firm

4508 SW 129th Ave
Miramar, FL 33027

754-432-7259

Contact information: Client Information

Prefix

First name *

Middle name

Last name *

Date of birth

Emails

Address *

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Addresses

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Phone numbers

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Is this your residential property?

Yes

No

Provide the property address in question

What was the date of the loss?

When did you first notice the damages?

Put the closest date

Provide a description of how the loss happened.

Has the claim been reported to your insurance company?

Yes

Name of your insurance company When did you report your claim?

(mm/dd/yyyy)

Who reported the claim?

No

Has any inspections occurred?

Yes

Has there been a final decision?

No

Have you conducted any mitigation?

Yes

Name of the mitigation company Did you sign any agreement with the mitigation company?

No

Have the repairs been completed?

If yes, you can upload pictures. If your file is too large there will be an option to provide pictures later.

Yes

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THANK YOU

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