I/We, (the “Insured”), hereby agree to the retention of Allclaims Pro, a public adjusting firm, to provide representation of the Insured’s interest for loss or damage that occurred at the address of loss specified below.

I/We, the “Insured” hereby direct the insurance carriers to communicate with and provide information to the below named public adjuster as if he was himself the Insured. I/We the "Insured" further authorize and request that the Insurer include the name of the Public Adjuster firm, Allclaims Pro as an additional payee on all payments related to the above-referenced claim. I direct the Insurer to process all payments directly to Allclaims Pro at PO BOX 345, Front Royal, VA 22630.

I authorize Allclaims Pro to distribute these funds as required for prompt settlement of this claim. Allclaims Pro may withdraw from representation of the "Insured's" interests if Allclaims Pro deems that insurance coverage is not warranted.

Adjuster: Joe Walsh
Virginia License - 1145266 | West Virginia License - 19333278 | Maryland License  - 3000706320
PO BOX 345, Front Royal, VA 22630 – 540.252.0479 – [email protected] – VA

Allclaims Pro:
Virginia License - 138119 | Maryland License - 3000791746 | West Virginia License - 100281098

Insured Contract Date:
Address:  
Phone Number/Email:  
Insurance Company/Claim # (if known): /  
Policy Number:  

Accepted/Insured Signature: