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Contractor Form

Please fill out this form with the property owners information and your information.

Contact Us If You Have Any Questions

Phone

Email

800.935.9270

info@ATAclaims.com

Property Owners First Name

Property Owners Last Name

Property Owner's Phone Number

Property Owner's Email

Property Owner's Insurance Company

Property Type

Date of Loss

Loss Type

Hurricane

Tornado

Hail

Wind

Water

Fire

Property Address

Description of Property Damage

Contractor's First Name

Contractor's Last Name

Contractor's Phone Number

Contractor's Email Address

Contractor's Company Name

Anything we should know before contacting the property owner?

Upload Photos/Videos/Etc.

Upload File

Upload supported file (Max 15MB)

How did you hear about us? Please add Business Development Representative's name, if applicable

Did you explain to the property owner that someone from ATA would be calling them?

Thanks for submitting!

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