916-641-9550 altec@cwo.com

Submit a claim.

Please fill out the form below to submit a claim to us.

Today's Date (YYYY-MM-DD)

Your Name (required)

Loss Location Address

City

Zip

Mailing Address (if different than loss address)

City

Zip

Primary Contact Number (required)

Alternate Contact Number (required)

Date of Loss (YYYY-MM-DD)

Your relationship to the claim.

Description of Loss

Your Email (required)

Please answer this question:
1+1=?