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Letter Of Representation

Name

This field is for validation purposes and should be left unchanged.

What’s the homeowner’s name?(Required)

First Last

What’s the homeowner’s email?(Required)

What are the homeowner’s initials?(Required)

Initials (e.g. SAB)

Is there a second person on the insurance policy?(Required)

You can find this information on your insurance policy's declarations page. You can also find it by calling your insurance company.

What’s the second homeowner’s name?(Required)

First Last

What’s the second homeowner’s email?(Required)

What are the second homeowner’s initials?(Required)

What’s the insurance policy number?(Required)

You can find this information on your insurance policy's declarations page. You can also find it by calling your insurance company.

Who is your insurance company?(Required)

How long have you had your current insurance company?(Required)

Have you ever filed an insurance claim for the roof at this property?(Required)

What was the outcome of that prior roof claim?(Required)

What’s the claim number? (If not yet filed, leave blank)

If you have already filed a claim, add the claim number here. If you have not filed your claim, leave this blank.

What’s the date of loss?(Required)

What’s the cause of loss?(Required)

Can you provide a description of the loss?(Required)

An example would be, "Roof damage" or "roof damage with leaks inside the home" etc.

What’s the homeowner’s address?(Required)

Street Address Address Line 2 City State ZIP Code

Who is the InHouse public adjuster?(Required)

What is the approximate time of loss?(Required)

If unsure, put 12 p.m.

What’s the homeowner’s phone number?(Required)

What’s the public adjusting fee?(Required)

What is the name of the roofing company and name of the roofing sales rep who is referring the homeowner to InHouse?(Required)

If you were referred by a roofing contractor, please include the company name and sales rep.

What's the email address of the roofing sales rep who is referring the homeowner?(Required)

This email will get a copy of the signed Letter of Representation once ALL parties have signed.

Can you upload a photo of your insurance declarations page and any roofing contract you have?

Please upload a photo of your insurance declarations page. If you have a contract with a roofing company, upload the contract or a photo of the contract here. You can also email a copy of your contract to Claims@inhouseadjusting.com (NOT REQUIRED)

Drop files here or

Max. file size: 128 MB.