Westchase Legal Center

12950 Race Track Road #204
Tampa, FL 33626

813-926-0222

Please carefully fill out this form to the best of your ability. We appreciate that it is not the shortest form ever created, but we assure you these questions are necessary to make sure we can provide the best representation to you possible. If you need assistance understanding any part of the form, do not hesitate to contact us via phone or text at (813) 926-0222 or email at info@westchaselegalcenter.com. Your cooperation is crucial in documenting the damage and ensuring a smooth claims process.

Please be aware that completing this form does not create an attorney client relationship between you and Westchase Legal Center.

Privacy Policy

All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy. The data submitted via this form is encrypted and secured using industry-standard 256-bit SSL encryption.

Contact information

Prefix

First name *

Middle name

Last name *

Emails

Address *

Type

Upon submission, a copy of this form will be sent to the primary email.

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Addresses

Street address

Country

City

State/Region

Zip/Postal code

Address type

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Phone numbers

Phone number

Type

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Is the address listed above the address of the damaged property?

Yes

Are you the legal owner or an aurthorized representative for the damaged property?

Yes

What is the legal name of the owner of this property?

What is the date you purchased this property?

What is the current type of ownership for this property?

What is the type of property that suffered damage as a result of the storm?

What type of deed is reordered on the property?

Is there a mortgage or other lien on this property?

Yes

What was the date of the storm that damaged your property?

What type of damage(s) occurred to this property as a result of the storm? (Select all that apply)

WindFloodFireOther

To the best of your ability, please provide a description of the damage sustained?

What are the estimated cost of repairs (if known)?

Were there any injuries as a result of the storm's damage to the property?

Yes

If possible, please attach any and all photographs and/or videos of your property showing either the condition of the property prior to the storm as well as any photos or videos showing the damage sustained by the property as result of this storm.

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What is the name of the primary insurance company for the property?

What is the policy number?

What was the date of your last policy renewal?

What types of coverage does this policy provide?

What was/were the claim number(s) assigned to your claim?

Have you filed a claim with any insurance company as a result of the damages sustained to the property by this storm?

Yes

Was there an active flood insurance on this property on the date of the storm?

Yes

Do you have any other insurance policies one this property?

Yes

Have you received any insurance proceeds as result of the damage to this property from the storm?

Yes

If possible, please attach a copy of any and all correspondence received from ANY insurance company in regard to damage sustained the property as a result of this storm.

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Have you hired any contractors or repair companies to assess or repair the damage?

Yes

Have you received any financial assistance or grants related to the hurricane damage (not including insurance proceeds)?

Yes

Have you spoken to any other attorneys about this matter?

Yes

Is there anything else you think we should know about your situation?

Are there additional documents that you believe we should review in regard to your claim. If possible, please attach them below.

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