SPC Engineering - Property Claims Form

Property Claims Form

New Assignment Request

Insurance Claim - Damage Evaluation

Please complete the form below to submit a new assignment to SPC Engineering

If you would prefer to contact us by phone, please call (714) 630-0321.

Once submitted, we will contact the insured, or yourself if requested, to schedule an inspection.
An email confirmation will be sent to you when the inspection has been scheduled.

**Contact me prior to scheduling an inspection:

Yes, via Phone

Yes, via EMail

No, thank you

Client Information

Company Name *

Contact Name *

Main Phone No. *

Cell Phone No.

Business Phone No.

Email Address *

Business Mailing Address *

Business City *

Business State *

Business ZIP *

Referred By

Insured Information

Insured/s Name/s *

Main Phone No. *

Alt. Phone No.

Insured's Email Address

Alternate Contact Information

Alternate Contact Name

Main Phone No.

Alt. Phone No.

Relationship

Site Information

Site Address *

Site City *

Site State *

Site ZIP *

Date of Loss *

Claim Number *

Exchange Entity

Damages Claimed and/or Additional Information*
Please include a general description of the areas of concern/damages along with their locations on the property and any relevant background information. Also include additional homeowner concerns that you would like us to address and additional questions that you have about the damage.

If available, please e-mail any photos or information/documents you would like us to review to This email address is being protected from spambots. You need JavaScript enabled to view it..

Name