Note If you need help for repairs or other emergency services perhaps one of our Helper Network members can help you.click here

Report a Miscellaneous Type Claim

Important Report the accident to us immediately with whatever information you have. Do not wait until you gather all the information. Many times we can start the processing your claim with very little information.

IDENTIFY YOUR POLICY

Policy Number
Date of Loss

IDENTIFY THE NAMED INSURED

First name *
Last name *
Company name, if any
Contact name, If any
Daytime telephone number
Alternate telephone number
Email address *

LOCATION OF THE ACCIDENT

Street where loss occurred

City
State
Was loss reported to police?	Yes No	If yes complete the following
Name of Police Department

BRIEFLY DESCRIBE WHAT HAPPENED

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