Auto Claim

Your Name:
Telephone Number:
- -
Date of Loss:
Location:
Police Department Involved:
Ticket Issued:
Event #:
Description of Accident:

Year:
Make:
Model:
V.I.N.:
Plate:
Extent of Damages:
Present Location:
Driver:
Date of Birth:
License Number:
State:
Permissive User?:
 

Year:
Make:
Model:
Extent of Property Damage:
Owner:
Phone:
- -
Address:
City:
Zip:

Insurance Information

Company Name:
Policy Number:
Agent Name:
Phone:
- -

Name:
Phone:
- -
Address:
City:
State:
Zip:
Extent of Injury:

Name:
Phone:
- -
Address:
City:
State:
zip:
Is damaged auto essential to business?:
 
If yes, describe how?:
Enter answer to the math question:
Recaptcha image (Audio)



INSTRUCTIONS TO INSURED:

If still on the scene:

  1. Contact police.
  2. Obtain information about other people involved in the accident or anyone who may have witnessed the accident.
    • Name
    • Address
    • Phone number
    • Insurance carrier
    • Policy number
    • Etc.
  3. Take photos of the accident, if camera available.
  4. Have vehicle towed if unable to drive.

If not on the scene:

  1. Obtain two estimates for repair if vehicle can be driven.
  2. The claims adjuster will either approve one of these two estimates or send an appraiser to see the vehicle.
  3. The claims adjuster will deal directly with the other people involved in the accident; you should not deal with them yourself.
  4. The insurance company will contact you within 48 hours.
    • If there is any reason that you need to be contacted immediately, please let us know.

Ready to get started?

Our staff of experienced insurance professionals can develop programs that make sense for your company and your employees.
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(702) 877-1111


You can also report a claim using our online forms here.
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