For Insurance Co’s ADJUSTER ASSIGNING CLAIMAdjuster First Name* Adjuster Last Name* Email* Adjuster Cell / Extension* CARRIER INFORMATION TO INVOICECarrier Company* Carrier Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code CLAIMANT INFORMATIONClaimant First Name* Claimant Last Name* Loss Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Claim Number* Primary Phone*Secondary PhonePUBLIC ADJUSTERPublic Adjuster Name Public Adjuster Primary PhonePublic Adjuster Secondary PhoneTYPE OF DETECTION NEEDEDType - Choose all that apply:* Cause & Origin Sewer Inspection Slab Leak Irrigation Pool Other (Describe in comments section) Brief Description of problem:*Add AttachmentAccepted file types: jpg, gif, pdf, png, Max. file size: 5 MB.Submission Agreement* Submission of this form indicates an agreement between Sleuth Inc. and the Insurance Carrier to issue payment directly to Sleuth Inc.