Insurance Registration
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INSURANCE REGISTRATION IN RAINBOW INFORMATION MANAGER
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INSURANCE COMPANY NAME:*
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| AUTHORIZED CONTACT: Please use the BROKERS Information |
Brokerage Company Name:
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Salutation: |
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| Broker First Name: |
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Title: |
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| Broker Last Name: * |
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Home Phone: |
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Emergency Phone: |
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Ins. Co. Affiliated With:
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Cell Phone: |
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| Do Not Call: |
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| BILLING INFORMATION FOR THE INSURANCE COMPANY (or Adjuster after claim has been initiated to provide info): |
| Referred By: |
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Office Fax: |
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Adjuster Phone: |
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c/o Department: |
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| Building Address: |
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City: |
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QUESTION BLOCK - Enter all answers as shown below
1. Corporation Insurance Deductible: "Deductible is $__________"
2. Is flooring included in the Standard Unit Definition?: "Flooring included" or "Flooring not included"
3. In order for Rainbow International to provide services according to IICRC S500, 3rd Edition, the removal of damaged Laminate flooring or other unsalvageable items is required at the time of the emergency service. Is Rainbow International authorized to remove unsalvageable flooring at time of emergency to mitigate further damage?:
"Authorized to remove flooring" or "Not Authorized to remove flooring"
Note: Mgmt will work out invoicing and charge back to the unit accordingly.
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ADDRESS OF THE BROKERAGE: If different from above
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| ADDITIONAL INFORMATION: |
| Services of interest: |
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Lead Source: |
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| On-line Education, CEC Courses, brochures, Magnets Business Cards, Webinars |
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Download our Free White Paper to learn more information on Rapid Structure Drying. To find your nearest Rainbow International Location please use the search engine on our Corporate website by inputting your Postal Code.
Estimating: Restoration Estimates Price Match in effect for identical scope.
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| Scope to Estimate: |
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Price to Match: |
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| If you know the following information please enter it, otherwise leave it blank. |
| Portal Application: |
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Portal Name: |
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Rainbow International of North York www.rainbowintl.com/northyork
416-398-3090 One Phone Number for the CARE System 1-888-4-FLOOD-911
To View the CARES Forms Click Here
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