claim

Property Loss Claim Form

Please click here to find out what to do if you have a homeowners / property loss.

What To Do If You Have A Homeowners / Property Loss

Take reasonable and necessary steps to protect the property from further damage or loss. This includes contacting a water mitigation / restoration company.
If the loss involves theft or vandalism notify the police.
Report the claim to your insurance agent. We will review coverage and deductibles with you and report the claim to your insurance company.
Keep a record of all repair costs, including your labor, and retain receipts for any expenditures.

Please fill out the following form to begin the process of making claim.

Named Insured / Person to Contact About Incident	Phone
	Email Address

Facts

Date of Loss	Time a.m. p.m.	Weather
Location
Description of Incident
Who was notified?

Name	Phone
Address	State	Zip Code

What action was taken following damage?

Property

Description of Property Involved

Estimated Amount of Loss

Party Responsible for Loss

Name (Individual or Firm) - That caused loss, if known	Phone
Address	State	Zip Code

Witnesses

1)	Name	Phone
	Address	State	Zip Code

2)	Name	Phone
	Address	State	Zip Code

3)	Name	Phone
	Address	State	Zip Code

Police Report

Department

Officer and ID No.

Report No.

Remarks

Reported by (Person Completing Report)	Date
Authorized Supervisor	Date

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