Insurance Claim Support | Roof Gutter Now

Insurance Claim Authorization — Roof Gutter Now

Homeowner Information

First Name *

Last Name *

Property Address *

City *

State

ZIP *

Phone Number *

Email Address *

Insurance Information

Insurance Carrier *

Policy Number *

Claim Number (if filed)

Adjuster Name (if known)

Adjuster Contact Info (if known)

Scope of Authorization

By signing this agreement, the homeowner authorizes Roof Gutter Now to:

Act as a third-party representative to communicate with their insurance carrier.
Provide necessary documentation, photos, and reports to facilitate the claim process.
Request re-inspections, supplements, or appeals if necessary to maximize claim approval.

Contingency Agreement & Contractor Selection

If the insurance company approves any portion of the claim for roof, gutter, or exterior/interior restoration, the homeowner agrees that Roof Gutter Now is the selected contractor.
The homeowner agrees to allow Roof Gutter Now to complete installation at the insurance-approved scope and pricing.
The homeowner understands that no out-of-pocket costs will be due beyond their insurance deductible, any chosen upgrades, and uncovered repairs (if applicable).
This agreement does not obligate the homeowner if the claim is denied, but if any work is approved, only Roof Gutter Now may perform the installation.
If the homeowner chooses not to move forward after an approval, they are responsible for a cancellation fee of 15% of the approved total.
The homeowner agrees not to contract another company or negotiate pricing with the insurance carrier outside of Roof Gutter Now.

This agreement is not a sales contract. Any modifications outside the insurance scope must be separately agreed upon. Roof Gutter Now is not responsible for claim approval or denial — all decisions are made by the insurance carrier.

Homeowner Signature *

Type your full legal name to sign

By confirming your name below, you agree this constitutes a legally binding electronic signature.

Roof Gutter Now Representative

RGN Rep / Sales Associate Name * The Roof Gutter Now team member assisting with this claim.

Company Representative Signature (office use only)

Roof Gutter Now Representative · Date: ___________

A signed copy will be emailed to you — reply ACCEPT to that email to make it official. You can also download a PDF copy.

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Agreement Signed & Submitted

Questions? Call (330) 222-6290 or email claims@roofgutternow.com

Insurance Claim Authorization & Contractor Selection Agreement

Agreement Signed & Submitted