Claim Report | Adams Insurance Service

Commemorative Obamacare Timeline

ABSOLUTELY FREE!
NO CO-PAYS!

Norm's 20

Keep up with our fearless leader right here! Join the fight or just admire the grit.

Texans for Sensible Immigration Policy (TXSIP)

Citizens Against Lawsuit Abuse (CALA)

Our Team

See the full list of our family.

Contact Us Today!

Adams Insurance Service Inc.
427 West 20th Street, Ste 500
Houston, Texas 77008
Phone: 713-869-8346

Toll Free: 800-438-8346

Claim Report

By Administrator on Fri, May 21, 2010

Please, fill the following from to submit your Property Loss Report.

If you prefer to send your request by fax or mail. Click here to download the PDF version.
Remit to:

Adams Insurance Service Inc.
427 West 20th Street, Ste 500
Houston, Texas 77008
Fax: 713-869-9144 Phone: 713-869-8346

Submitter Information

Submitter Name: *

E-mail: *

Date of Loss: *

Time of Loss: *

:

am

pm

Location of Loss

Location Name or Code: *

Address: *

Description of Loss: *

Police / Fire Department Investigating:

Police / Fire Department Case #:

Description of Items Damaged / Taken:

Employee Witnesses

Witnesses #1

Name:

Position:

Phone:

Witnesses #2

Name:

Position:

Phone:

Other Witnesses

Other Witness #1

Name:

Home Phone:

Work Phone:

Mobile Phone:

Address:

Address, City, State and Zip code.

Other Witness #2

Name:

Home Phone:

Work Phone:

Mobile Phone:

Address:

Address, City, State and Zip code.