If you would like to have one of our contractors assist you on a claim, please fill out this assignment log and press the submit button below. If you prefer, you may print out this form, then mail or fax it to:

First General Services
6451 North Federal Highway, Suite 121
Fort Lauderdale, FL 33308
Fax: (954) 537-4942

Please indicate if you require any emergency services:
Board up Dry out Wet carpet pick up
Claim #:
Date of Assignment:
Claims Person:
Date of Loss:
Insurance/Adjusting Company:
Telephone:
Fax:
Email:
Their File #:
Type of Loss:
Special Instructions:
Name and address(es) of insured:
Policy #:
Telephone(s):
Names and addresses of other interested parties:
Telephone(s):
Date of Inspection:
Loss location:
Contracting or Restoration services required:

Please check box if you would like confirmation of this assignment upon receipt?

Would Like Confirmation



Phone: (800) 523-3680 | Fax: (954) 537-4942 Email: info@firstgeneralservices.com
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