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Claim Report

Use this form to submit your Property Loss Report.

If you prefer to send your request by fax or mail. Click here to download the PDF version.
Remit to:

Adams Insurance Service Inc.
427 West 20th Street, Ste 500
Houston, Texas 77008
Fax: 713-869-9144    Phone: 713-869-8346

Submitter Information
:
Location of Loss
Employee Witnesses
Witnesses #1
Witnesses #2
Other Witnesses
Other Witness #1
Other Witness #2
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