New Assignment Of Benefits Submission First Name* Last Name* Your Number* Your E-mail* Company Name* Insured & Claim Details Policy Holder's Name* Property Address* Insurance Company Policy Number* Claim Number* Work Conducted* ---Water ExtractionMold RemediationMold TestingRoof TarpRoof WrappingRoof Repair/ReplaceMoisture TestingBuild-BackOther Describe* Date of Loss Cause of Loss Date AOB signed Date Work Conducted Claim Result ---DenialUnderpaymentNo responseOther Explain: Amount of Invoice Add another Invoice? NoYes Note: Use "Yes" if its related to the same property. Policy Number (leave blank if same) Claim Number (leave blank if same) Work Conducted* ---Water ExtractionMold RemediationMold TestingRoof TarpRoof WrappingRoof Repair/ReplaceMoisture TestingBuild-BackOther Describe* Date of Loss Cause of Loss Date AOB signed Date Work Conducted Claim Result* ---DenialUnderpaymentNo responseOther Explain: Amount of Invoice Add another Invoice? NoYes Note: Use "Yes" if its related to the same property. Policy Number (leave blank if same) Claim Number (leave blank if same) Work Conducted* ---Water ExtractionMold RemediationMold TestingRoof TarpRoof WrappingRoof Repair/ReplaceMoisture TestingBuild-BackOther Describe* Date of Loss Cause of Loss Date AOB signed Date Work Conducted Claim Result* ---DenialUnderpaymentNo responseOther Explain:* Amount of Invoice* Upload Files or send link for Download? ---UploadSend LinkContact me Upload files Directly to our Server - I waited for all files to upload and hit 'Submit these files' before clicking the below Submit button. Link to files - I agree to the terms of the rolling retainer agreement previously executed with Watson et Barnard PLLC. Erik BarnardAOB NEW JOB04.01.2022
