Submit a Claim

To Submit a claim you can call us (1.888.212.5815), email us ([email protected]) or fill in the form below:

Claim Information
Claim Number*
Date of Loss*
MM slash DD slash YYYY
Pre-Approved Nightly Rate
This field is optional: Please specify the pre-approved nightly rate for immediate placement options, otherwise Accomsure will conduct a market scan (ASO) and seek formal approval in email.
ALE Limits
Type of Policy*
Type of Loss*
Adjuster Information
Adjuster Name*
First Last
Adjuster Company*
Adjuster Phone*
Adjuster Email*
Adjuster Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Additional Adjuster Information
Hotel Approval
Nights Approved
Estimated Check-In Date
MM slash DD slash YYYY
Long Term Housing Approval
Estimated Length
Policy Holder
Policy Holder Name*
First Last
Policy Holder Phone*
Policy Holder Email
Policy Holder Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of Adults
Number of Children
Other Info
- Pets?
- Smoker?
- Special Accessibility Required?
Comments
Phone
This field is for validation purposes and should be left unchanged.

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