Report a New Loss

Please use the form below to report a new loss. If you have any questions, please feel free to call us at 305-234-5000 or email us at fabricrestoration@sirgalloway.com.

Fabric Restoration Signup - REVISED 02-11-2014

Type of Restoration Fire Water Diesel Fume

Customer Information

---

Name (Insured) *

Address of Claim *

City *

State *

Zip Code *

Cell Phone *

Home Phone

Work Phone

Email Address *

Insurance Company Information

---

Insurance Company Name

Phone #

Adjuster Name *

Email Address *

Other Information

---

Special Instructions