Type Of Restoration
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| Fire Water Diesel fume |
Customer Information
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| Name (Insured) |
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| Address Of Claim |
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| City |
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| State |
Zip Code |
| Home Phone |
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| Work Phone |
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| Cell Phone |
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| Temporary Home Address |
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| City |
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| State |
Zip Code |
| Temporary Home Phone |
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| Insured's Email |
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Insurance Company Information
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| Order Referred By Company Name |
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| Name |
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| Address |
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| City |
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| State |
Zip Code |
| Claim # |
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Contact Person Or Adjuster Information
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| Name |
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| Address |
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| City |
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| State |
Zip Code |
| Office Phone |
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| Cell Phone |
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| Fax |
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| Email |
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Public Adjuster Information
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| Company Name |
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| Name |
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| Address |
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| City |
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| State |
Zip Code |
| Office Phone |
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| Cell Phone |
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| Fax |
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| Email |
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Other Information
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| Desired Pickup |
Date Approximate Time |
| Payment Procedures |
Send invoice to contact person
Send invoice to restoration contractor
Customer will pay direct |
| Special Instructions |
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Sir Galloway Dry Cleaners, Inc. guarantees to remove smoke or diesel fume odors. Payment is required on or prior to delivery. Delivery for “special orders” is five days after the date of pick up. Regular work is delivered four to five weeks after date of pick up.. You will receive order confirmation Monday through Friday within 24 hours. Orders submitted over the weekend, please allow 48 hours. |
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