Has your property suffered physical damage?

Client Claim Form

Date of loss

ADDITIONAL LOSS

Date of loss

ADDITIONAL LOSS
Date of loss

The foregoing constitutes client's electronic signature and client hereby agrees and consents to all content included herein, and has read and understood the retainer terms and conditions and client understands client is hiring legal counsel for the matter(s) noted herein.

By checking this box you affirm that you have thoroughly read and understood the terms and conditions of retainer agreement provided herein. You understand you are hiring legal counsel for this matter and you further understand you are free to hire any attorney of your choosing, but have chosen to retain The Cardenas Law Group, LLC, and you are doing so freely, knowingly, and intelligently.

Fraud Statement Pursuant to s. 817.234, Florida Statues, any person who, with the intent to injure, defraud, or deceive any insurer or insured, prepares, presents, or causes to be presented a proof of loss or estimate of cost or repair of damages property in support of a claim under and insurance policy knowing that the proof of loss or estimate of claim or repairs contains any false, incomplete or misleading information concerning any fact or thing in material to the claim commits a felony of the third degree, punishable as provided in s.775.082 s.775.803, or s.775.084, Florida Statues,

“PLEASE MAKE SURE TO REVIEW AND SIGN THE RETAINER AGREEMENT AND CLIENT BILLS OF RIGHTS. ONCE YOU SIGN BOTH FORMS AND SEND YOU SHOULD RECEIVE A COPY OF BOTH SIGNED DOCUMENTS. PLEASE VERIFY YOUR EMAIL IS CORRECTLY NOTED ON THE CONTACT FORM BEFORE SENDING. IF YOU DO NOT RECEIVE AN EMAIL WITH A COPY OF THE DOCUMENTS, PLEASE CALL US AND ADVISE.”