Contract – Ruffin Roofing

Insurance Claim Contract

Please fill in and sign this form.

Please enable JavaScript in your browser to complete this form.

Date / Time

Name

First

Last

Home Phone

Cell Phone:

Work Phone

Address

Address Line 1

Address Line 2

City

State

Zip Code

Insurance Company

Claim Number:

Claim Center #

Adjuster Name

Adjuster's Phone

Appointment Date / Time

Date

Time

Please check each box to acknowledge you have read and understood each point.

I understand that Ruffin Roofing or its representatives are not public adjusters and cannot act as such. I, the homeowner, must contact the insurance company and make them aware of the damages.
I agree to allow Ruffin Roofing, to communicate with my insurance company; meet my adjuster to discuss the damages and payment to restore the property to its original condition as written in my insurance policy.
I understand that my insurance company will compile a loss statement, a description of the work to be completed on the above said property. I agree to make a copy available to Ruffin Roofing.
I agree to have all checks made payable or endorsed to be made payable to Ruffin Roofing.
I understand that all work is to be performed in accordance with my insurance company’s loss statement.
I understand that any upgrades or additional work requested, which is not covered by my insurance company, will be my financial responsibility.
I understand that my insurance will pay all expenses to repair my property to it’s prior condition, less my deductible. My only financial responsibility is to pay my deductible.
I understand that Ruffin Roofing will begin on the above said property upon the insurance company’s approval
If only partial approval is granted for any portion of the work, I agree to allow Ruffin Roofing to attempt to reach an acceptable resolution to repair the damage to the property.

Project Manager Signature:

Homeowner Signature

Please note: This contract constitutes full accord and agreement of all parties, and no other understanding, verbal or otherwise, shall be binding unless in writing, and signed by all parties.

“You the buyer may cancel this contract anytime prior to midnight of the third day as dated above on this binding contract.”

Insurance Claim Contract

Let's get in touch