Housing Request

Klein & Co. is ready to assist your policyholder with their temporary housing needs. Please enter your information below. A Klein & Co. representative will be in touch with your policyholder shortly. If you are submitting a claim outside of the hours of 6:30 AM-6:30 PM MST, please call (800) 208-9826 x119 to notify the On Call rep of your claim.


Adjuster Information

Please enter the Adjuster Name into the Notes field
Notes:

Adjuster Email:

Insurance Company:

Carrier Claim Number:

Homeowner Information

Policyholder Name:

Policyholder Phone:

Policyholder Email:

Date of Loss:

Type of Loss:

Loss Address-Street:

Loss Address-City:

Loss Address-State:

Loss Address-Zip:

Type of Relocation

FRV:

Hotel:

Temp Housing:

Housing Requirements

Type of Housing:

Desired City:

Desired State:

# of Adults:

# of Children:

Requested Move in Date:

Requested Bedrooms:

Requested Baths:

Length Needed:

ALE Limit:

Pet #1 Type/Breed:

Pet #1 Weight:

Pet #2 Type/Breed:

Pet #2 Weight:

Pet #3 Type/Breed:

Pet #3 Weight: