Customer Application | Wonder Restoration

Full Name*

Your Email*

Phone Number*

Mailing Address*

Property Address (If Different)

Reason for Service (Select All that Apply)*

Water Damage

Fire Damage

Smoke Damage

Crime Scene Cleanup

Biohazard Cleanup

Other

Date of Incident*

Do you have insurance coverage for this type of damage?*

Yes

No

Insurance Company Name

Policy Number

Claim Adjuster Name

Claim Adjuster Phone Number*

Additional Information*

Preferred Date of Service*

How did you hear about Wonder Restoration?*

Search Engine (Google, Yahoo, etc.)

Social Media

Friend / Family

Blog or Publication

Other

Application Terms*

I understand that this is a preliminary applicationform and that a Wonder Restoration representative will contact me to dicuss my specific needs and requirements. I understand that all information will be kept confidential. I understand that I am responsible for payment of services rendered by Wonder Restoration LLC.

Wonder Restoration LLC Client Application Form