Submit a Claim

To submit a claim with Crown Cleaners, please fill out the form below.

**Please note that ALL fields are REQUIRED. **

NOTE: (Extract from Sec. 556 of the Insurance Code).
It is unlawful to present or cause to be presented any false or fraudulent claim for a loss under a contract of Insurance.
Violations are punishable by not over three years imprisonment in state prison or by fine up to $1000.00 or both.

First Name

Last Name

Telephone

Your Email

Address

City

ST

Zip




I hereby certify that the following article, owned by me, was lost or damaged while in your possession.


DESCRIPTION OF LOST OR DAMAGED ARTICLE (Please complete all details)

Type of Article

No. of Pieces

Size

Color & Shade

Label Marking

Other descriptive details

Location of Service


HISTORY OF THE LOST OR DAMAGED ARTICLE (must be complete)

Date & Year Purchased

Price Paid

Name of Store

Store Address

# of Seasons Worn or Used

# of Times Dry Cleaned

Have we your permission to verify these facts with the store?


BASIS FOR CLAIM (Please complete all details)

Date Sent to Cleaner

Please Choose One

Extent of Damage

Circumstances


PLEASE UPLOAD ANY FILES OF YOU MAY HAVE TO HELP US BETTER EVALUATE YOUR CLAIM
File size limit is 50MB

To remove your image, please click "Choose File", then "Cancel".
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Download our Claim Policy