CCI
Contract Callers, Inc.
Field Service Damage Claim Form
Confidential — internal use only
✉
Submitting to management
Lelliott@contractcallers.com • Jharris@contractcallers.com • Lbohling@contractcallers.com
Claim information
Claim reference number
Date reported
*
Select the date reported.
Customer information
Customer name
*
Customer name is required.
Service address
*
Service address is required.
Phone number
Email
Service details
Date of service visit
*
Select the service visit date.
Incident details
Description of incident
*
Describe the incident.
Description of damage
*
Describe the damage.
Date damage noticed
Was customer home?
Yes
No
Unknown
Photos available?
Yes
No
CCI use only
CCI representative
Date
Submit claim →
✅
Claim submitted
Your email client opened with the completed claim. Hit
Send
to deliver it to management.
Lelliott@contractcallers.com • Jharris@contractcallers.com • Lbohling@contractcallers.com