INSTRUMENT DAMAGE ASSESSMENT

ALLEN ORGANS OF THE EMERALD COAST
INSTRUMENT DAMAGE ASSESSMENT

This form is to assist you in making a claim to your insurance company for damage to your organ, piano, sound system or other instruments. Please give us as much information that you have and just leave the fields blank if you don’t know the answer. There is no charge for this service. However, if an onsite visit is necessary there may be a minimal charge and your insurance company should cover it. Please call if you have any questions.

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Contact Name
Type of instrument (select all that apply)
Type of Damage (select all that apply)
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