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a: 3001 E. St. Sacramento, CA 95816
p: 916.418.9100
f: 916.418.9101
"Proactive participation that stresses multiple concept ideas in the schematics and design development phases."

Kelly Reynolds
Stafford King Wiese Architects

 
Request for Insurance Claim Inspection
   
Your Company Name:
Person Requesting Service:
Your Email Address:
Your Phone Number:
Your Fax Number:
Scope of Work Requested:
(please be as detailed as possible)
Please select delivery method of report & photo log:
email only (no hard copy mailed)  
fax only 
email & hard copy mailed
   
Bill To Address:
Claim Number:
Report of Claim: (mm/dd/yyyy)
Insured's First Name:
Insured's Last Name:
Loss Location:
 
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(Please list as many contact numbers as possible) Home  Work  Cell  Other 
  Home  Work  Cell  Other 
  Home  Work  Cell  Other 
  Home  Work  Cell  Other