Roof Inspection Request Form

• Date of Assist: * / /

  IF YOUR REQUEST IS FOR TODAY OR TOMORROW, PLEASE CALL OUR OFFICE AT (847) 752-4022 TO CONFIRM AVAILABILITY.

• Appointment Time:

  Appointment time "ANY" if independent appointment requested.

• Location Information

  Please fill out the information about the Loss below.
• Claim Number: *
• Insured's Name: *
• Loss Address: *
  United States Country
• Dwelling Type: *

  1 Story 2 Story 3 Story
• Roof Pitch :
  FKMK - 6/12 7/12 - 8/12 9/12 - 10/12 11/12 - PLUS

  This is not a required field, but if you know the pitch of the roof, please provide that information to us.

• Do you need the roof measured? *

  YES NO
• Service Requested: *

  Roof Inspection Full Roof & Exterior Inspection
• Special instructions such as:
  Aerial view or measurements needed; Xm8/drag and drop $10 requested; Roof other than comp; Three story ladder needs; Interior damage assist or leak detection
• Do Not Fill This Out