First name *

Last name *

Address *

City *

State *

Zip *

Email *

Phone *

Insurance Company *

Claim Number *

Adjuster Name *

Contact Info *

Notes: DOL *

Job Description *

Perform work according to the specifications and the amount received from the insurance company.

Customer only responsible for deductible and agreed upon upgrades.

If an insurance claim has been processed for your project, this contract price will vary based on insurance final payout. All monies received from the insurance company for the project included but not limited to supplements, contractor overhead and profit and/or any other monies paid will be added to this agreement, you understand that we will be completing all portions of the insurance claim as agreed between the company and the insurance carrier. If after we provide the preliminary services associates with establishing your claim and you choose NOT to use us for the project or a portion paid for by your insurance, then 15% (fifteen percent) of the project cost will be paid to ProFix. you also agree that services provided in the form of estimates, supplements, communication with the insurance and any other service starts this project and those services have real value and better the property directly.

Representative *

Represents ProFix

Home Owner / Insured *

By tying your full name you agree to the terms listed above

Home Owner / Insured

By tying your full name you agree to the terms listed above

Date time *

Thank you for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

Thank you for getting in touch!

We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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