Submit a Claim - FAZ CPAs

Claim Referral Form

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Claim Type

No-Fault, Business Interruption, Other

Name and/or Business Name of the Insured or Claimant

Claim Referral Number

Date of Loss

Anticipated Loss Period

Address of the Insured or Claimant

Address Line 1

Address Line 2

City

State

Zip Code

Insured or Claimant Phone Number

Cause of Loss

Insurance Company/Referring Company

Name of Claim Rep. or Adjuster

First

Last

Address of Claim Rep. or Adjuster

Address Line 1

Address Line 2

City

State

Zip Code

Claim Rep or Adjuster Phone Number

Claim Rep. or Adjuster Email

Additional Information

Do you have supporting documents to submit?

If so, please upload them below.

File Upload

Click or drag files to this area to upload. You can upload up to 10 files.

Please submit any supporting documents here. For No-Fault Claims, please enclose NYS Form NF-7, NYS Form NF-2, and income tax returns. For Business Interruption Claims, please enclose a copy of the policy, declaration page, and a description of the claim, along with the applicable financial records.

- Thomas Easley

- Joong Park

- Haartz Corporation/Tom Daigneault

- Jim Towne

- Matt Smith

- Arrow Bank

- Arrow Financial Corporation

- Cambridge Central School District

- Cambridge Central School District

- Anne Choppy

- Vincent M. Choppy

- Zalazar anelardo

- Jennifer Mulligan

- Guy Tombs

- Ashley Hart

- Peter Lee

- Dave Paliotti

- John Harwick

- Dan Dagostino