Online Claim...

California Emergency Services is realizes your time is valuable. To make our claims process more convenient for you we have started this online claim form. Please fill out the following information in its entirety and we will respond to your request as soon as possible.

Items marked with a * are required.
   
*Date of Loss: , 20
*You Are The:
*Your Name:
*Loss Site Address:
*City:
*State:
*Zip:
*Phone:
Claim Details: Please describe the situation
Do you want a call to confirm receipt of this request?
To what phone #?
 
*Additional information may be required to complete your claim

 

California Emergency Services
19821 Cabot Blvd., Hayward, CA 94545
PHONE: (510) 785-0102     FAX: (510) 785-1718

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