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Name *

Phone *

Business Name (if applicable)

Email Address *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Website (if applicable)

Type of License *IndividualBusiness EntityBoth

Are you currently in good standing with all state Departments of Insurance? *YesNo

State Issued Public Adjuster License *Please upload a copy of your current Public Adjuster license for your primary state and any additional states where you are licensed. If you prefer, you may upload a Sircon or NIPR license report showing all active licenses in lieu of uploading each individual license. The report must clearly display: Your full legal name, License numbers, License types, State(s) of issuance, & Expiration dates. Only clear, legible documents will be accepted.

Government-Issued Photo ID *

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Certificate of Insurance *Applicant must provide a current Certificate of Insurance showing active Errors & Omissions coverage with minimum limits of $500,000 per occurrence and $1,000,000 aggregate. Coverage must remain active while participating in the Valor Claims Solutions Preferred Network. Submissions without proof of E&O coverage meeting these minimums will not be accepted.

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Types of perils

Commercial claims

Licensed Public adjuster?