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ONLINE HOUSING REQUEST

Klein & Co. is ready to get started in helping you find the temporary housing that's right for you. Please enter your information below. A Klein & Co. representative will follow up with you by phone as soon as possible.

INSURANCE INFORMATION
Adjuster's Name Address
Company City
Phone State
Mobile Phone Zip
Fax # Preferred Method of Communication
Email
HOMEOWNER INFORMATION
Claim # Type of Loss
Policy Holder's Name Loss Address
City State
Zip Phone
Mobile Phone Alt. Phone
Date of Loss (MM/DD/YY) Type of Relocation FRV
Temp. Housing
Hotel
HOUSING REQUIREMENTS
Type of Housing # of bedrooms
requested
City Desired # of bathrooms requested
State Desired Length Needed
Boundary Limits ALE Budget
North Pet #1 Type/Breed
South Pet #1
Weight
East Pet #2 Type/Breed
West Pet #2 Weight
#of Adults Pet #3 Type/Breed
# of Children Pet #3 Weight

Requested Move-in Date
(MM/DD/YY)

 If you have more than 3 pets, please list additional animals below in Notes section
Notes

 

 
 
     

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Klein & Co.
914 Washington Avenue
Golden, CO 80401
Phone: 303-796-2100/800-208-9826
Fax: 303-796-2101/800-208-9827

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