Send Us Your Claim Information

It is important that we gather the necessary information from you so your claim can be processed quickly and efficiently. To report a loss due to new damage, please fill out the form completely and we will respond to your request as quickly as possible.

Our qualified staff at Century Construction Services will work with you in all aspects of the claims process and will be responsible for coordinating the construction process of restoring your property. We ensure that your restoration is handled right the first time.

Your Claim Information
First Name:		Last Name:
Contact Phone:		Contact Email:
Property Address:		Property Address 2:
City:		State:
Zip Code:

Insurance Company Name:
Insurance Policy Number:		Insurance Claim Number:

Type of Damage:	Water Damage Fire Damage Wind Damage Smoke Damage	Mold Remediation Hail Damage Other
Describe Damage in Detail: