CRDN of the Tri-Counties - Mold Removal and Restoration

Questions? Call
805.962.CRDN

Submit A Claim

To submit a claim, please use this form to fill in any information you have related to the claim. The most important pieces of information are the name, address, and phone number of the insured. After the CRDN operator has received your request, a member of their professionally-trained staff will contact you and the homeowner to schedule a pickup. Any concerns or special requests can be submitted in the "Pickup Notes" box. Thank you for using the CRDN of the Tri-Counties Online Claim Submission Service!

The fields marked with * are required.

Call-In Contact First Name
Call-In Contact Last Name
Insurance or Contractor Information
Company Name *
Adjuster/Contractor First Name *
Adjuster/Contractor Last Name *
Main Phone Number *	Example: 213-555-1212
2nd Phone Number
Fax Number
Email *
Insurance Claim No.
Home Owner Information
Owner First Name *
Owner Last Name *
Street Address *
City *
State *
Zip Code *
Main Phone Number *	Example: 213-555-1212
Work Phone Number
Alt. Phone Number
Service Information
Is this an emergency? *	Yes No
Contaminant *
Pickup Notes (limit 250 characters)