Automobile Insurance — Report a Claim

Please note that submitting a claim from this Web site does not confirm coverage or authorize payment.  An agency representative will verify your coverage and contact you to complete the claims process.

Important:  If this claim involves more than two people, please contact our agency directly to report it.
 

Account or Policy Number   (if you know it)
Full Name
Contact Information
Who should the claims adjuster contact regarding repairs?
Name
Home Telephone
Work Telephone
Email Address *REQUIRED
Authority Contacted
Police Department
Police Report Number
Claim Information
Date of Accident
Location of Accident
Cause of Accident
Describe, if other cause of loss
Injuries
Reminder:  If more than two people are involved, please contact our agency directly to report the claim.
Information about person injured  
Name
Address
Telephone Number
Nature of injuries
Information about person injured  
Name
Address
Telephone Number
Nature of injuries
Damage to Your Vehicle
Year, Make & Model
Driver Name
Driver Address
Driver Telephone Number
Describe the damage to your vehicle

Location of vehicle now
Damage to Other Vehicle
Year, Make & Model
Owner's Name
Owner's Address
Owner's Telephone Number
Driver Name
Driver Address
Driver Telephone Number
Describe the damage to the vehicle

Insurance agent and/or company

Accident Details
Describe what happened
Comments and/or other information