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Gemini Restoration - 45th Anniversary
Celebrating Our 45th Year Serving the Tri-State Area

24/7 Emergency Hotline
(877) 774-3646
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Submit a Claim

Please provide as much information as possible to help us serve you better...

Insurance Carrier:
Insurance Agent:
Referral Type:
Who were you referred by?
Referral Contact Name:
Referral Contact Number:

Insured/Resident Information

First Name:
Last Name:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Email:
 

Owner Information (If Different from Insured/Resident)

First Name:
Last Name:
Address Line 1:
Address Line 2:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Email:
 

Policy Information

Claim Reference #:
Policy #:
Deductible:
Policy Limits (Dwelling):
Policy Limits (Contents):
Policy Limits (Other):

Loss Information

Date of Loss:
Loss Type:
Is This an Emergency?
Loss Description (Additional Info About the Loss):
Special Instructions:

Adjuster Information

Adjuster:
Independent Adjuster:
Email Address (To Send Confirmation To):
 

Upload Images of Damages

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Note:If you need to send more images, please attach them to an email message and send it to info@geminirestoration.com. Please be sure to include your name and reference your claim number in the email.