General Intake Form

Let’s get things moving! Fill out the quick intake form so we can match you with a trusted 5-star vendor and start working on your claim. The sooner we get your info, the sooner we can help get things back to normal.

CCG Intake Form - General

Policyholder Name

First

Last

Policyholder Address

Policyholder Phone #

Policyholder Email Address

Job Type (select any that apply)

Loss Description (provide a brief description of the damage)

Date of Loss

Do you have any photos you would like to share?

Maximum file size: 516MB

If you are human, leave this field blank.