To Submit a Claim, please fill out the form completely and a FRSTeam representative will contact you. Name of Person Reporting Claim Phone Number Type of Loss Insured Name(s) Claim/Reference Number Loss Site Address Street Number City State Zip Code Insured Contact Numbers Home Phone Number Work Phone Number Cell Phone Number Email Authorized Items to pick up in affected areas Clothing Bedding Window Treatments Specialty Clean Items (Foot wear, Plush Toys, Accessories - Please List) On-site Special Instructions Hold For Bill Approval Yes NO Bill To Information: Company Name Address City State Zip Code Phone Fax Adjuster/Contact Email