Page 1 of 3 Please complete all required fields! Submit A Claim To Submit a Claim, please fill out the form completely and a DTRS representative will contact you shortly. Please type your full name. Invalid email address. Please List a Valid Contact Number Type of Loss FireSmokeWaterMoldPlease Check All That Apply Next > Step 2 Please list the address requiring our services. Please List Your Name or Company Please List Your Address Please List Your City Please List Your State Please List Your Zip Authorized Items To Pick Up In Affected Areas ClothingBeddingWindow TreatmentsSpecialty ItemsPlease Check All That Apply (ie: Footwear, Plush Toys, & Accessories) Please list any detailed instructions Are we HOLDING this project until bill is approved? YESNOPlease specify PrevNext > Step 3 Please let us know details of your Insurance & Claim Contacts Please List Your Insurance Company Who Do We Contact? What is your Agents Contact Number? What is your Insurance Claim or Reference Number with this Loss? List any instructions here. Invalid Input
