Please fill out the form below to submit a case or claim

Contact Name: (required)

Company: (required)

E-mail: (required)

Street Address:

Street Address Line 2:

City:

State / Province / Region

Postal / Zip Code:

Country:

Phone:

Case/Loss Name:

Name of Insured/Client:

Name of Claimant:

date of loss:

Claim Number/Your File Number:

Description of Loss:

Loss Location:

Date of Inspection:

Preferred Engineer:

Upload a File:

Upload a Second File:

*** By submitting this form electronically to CED Technologies Inc.:
CED Technologies Inc. (CED) has not been officially retained for this matter and this can only be done after CED has a signed retainer agreement with the client. CED does not give permission for any person or entity to represent a contract with CED and to do so is unlawful.***