Services
Goldstone Services Corporation

eClaim
Online Claim Submittal

 

 

Welcome to Goldstone Services eClaim online submittal form. In an effort to simplify your adjusting process we have provided this online form for your convenience.

We will contact the insured within one business day.

 

Submittals will receive a response confirmation.

 

If you have documents concerning this claim which you need to include, you may copy and paste them into the comments field of this form, or email as an attachment to claims@gldstone.com, or fax to 801.575.2199. 

 

Please fill out this form as completely as possible, using the TAB button to move from field to field. When you are done, click the SUBMIT button to send the form.

(*=Required)

Adjuster Information:

*Name 

*Company 
*Address 
*City  *State 

*Zip

*Phone Ext  
*Fax
*Email 
 
Insured Information:

*Name 

Address 
City 

State  

Zip 

Phone

Mr./Mrs./Ms.
Other 

Mr./Mrs./Ms.
Other 

Mr./Mrs./Ms.
 
Insurance Information:

*Claim #:

Have you contacted the insured party? 

Is it okay for Goldstone to call the insured party?

Scheduled amount

(blank if N/A)

Non-scheduled amount

(blank if N/A)

Deductible 

Will the deductible be applied elsewhere? 

 

Comments & Descriptions:

Would you like a receipt of acknowledgement?


Yes, via email

Yes, via fax
Yes, via my phone
No, thank you

 

 

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