Order Service FOR ANY NEW TARP INSTALLATION PLEASE COMPLETE THE SERVICE ORDER AND A REPRESENTATIVE WILL BE IN TOUCH SHORTLY. Property OwnerProperty Owner First Last Loss LocationLoss Location Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone - MobileEmail Homeowner Insurance Company InformationName of Insurance CompanyPolicy NumberClaim NumberDeductibleSingle Story YES NO Roof PitchType of RoofShingleTileMetalFlatInterior Water Damage Yes No Interior Rooms Damaged Entry Living Room Dining Room Kitchen Bedrooms Other Insurance Company Adjuster Contact InformationInsurance Adjuster Name First Last Adjuster PhoneAdjuster Email Describe the DamageSignature(Required)Consent to Invoice Insurance Carrier Directly.(Required) Owner/Policyholder authorizes Complete Cover to invoice the insurance carrier directly for Tarping Services. Complete Cover is Authorized to Collect Direct Payment from the Policyholder’s Insurance Carrier for Tarping Services Only.