Report a Loss

If you need to report a loss or receive help from F.Lax, please fill out the form below. An F.Lax representative will get in touch with you as soon as possible.

If you are an agent or adjuster, please complete the section For Agents/Adjusters Only.

For questions, please call 1-800-547-1914.

Report a Loss

First Name *

Last Name *

Email *

Company

Phone *

Mobile Phone

Do you own the property?

Yes

Is this an emergency?

Yes

Are you an insurance adjuster?

Yes

Property Owner Name

Property Address

City

State/Province

Zip/Postal

Country

Insurance Carrier

Type of Building *

Date of Loss *

Type of Loss

Loss Details

Photo Upload

Maximum upload size: 2MB

Comments

FOR AGENTS/ADJUSTERS ONLY

Please skip this section if you are not an agent or adjuster.

Approximate Sq. Ft. of Damage

Type of Loss

Rooms Affected

Contents Damaged in Loss

Claim Number

Adjuster Phone

Has Insurance Company Been Notified?

Insurance Adjuster Name

Insurance Agent Name

Agent/Broker Phone

Additional Instructions

If you are human, leave this field blank.