Please provide your contact information so our carrier can get in touch with you about your claim. This should include your phone number, email address, and any other relevant information they might need to reach you.

Describe the damage that occurred as a result of the incident. Please be as detailed as possible, including the type of damage, the extent of the damage, and any other relevant information that will help us process your claim more efficiently. You may also want to include any photos or other evidence of the damage if you have them.