Report an Auto Claim

Please note: Submitting a claim at this web site does not confirm coverage or authorize payment. A claims representative will verify coverage and contact you to complete the claims process.

If more than 2 people are involved, please call our agency directly to report the claim.

Policy Number:

Your Name:

Contact Person:
Whom should the adjuster contact about repairs?

Name:
Home phone:
Work phone:
Email address:

Authority Contacted:

Police department:
Report number:

Claim Information:

Date of loss:
Location of claim:
Cause of loss:
Describe, if other cause of loss:

Your Damaged Car:

Year/Make/Model:
Driver's name/address:
Driver's phone number:
Describe your damage:
Where is your car now?


Persons Injured:

Name and address:
Phone number:
Nature of Injuries:

Describe Other Car:

Year/Make/Model:
Owner's name/address:
Owner's PH#
Driver's name/address:
Driver's phone number:
Describe damage:
Insurance agent/company:



Describe What Occurred:

Comments and/or Other Information

If you have not received a response from us within one business day, please contact us again. Thank you.