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File A Claim
File A Claim
Step
1
of
2
50%
Select one of the following:
(Required)
Auto Glass Only
Auto
Home
Boat/UTV/Camper
Policyholder's Name
(Required)
First
Last
Date of Loss:
(Required)
MM slash DD slash YYYY
Time of Loss:
(Required)
Hours
:
Minutes
AM
PM
AM/PM
Driver of Vehicle:
(Required)
Vehicle Involved:
Type of Loss:
(Required)
Glass
Towing
Parked Vehicle
Collision
Hit and Run
Hail
Description of Loss:
(Required)
Location of the Loss:
(Required)
Driver of Other Vehicle:
Driver Information:
Police Contacted?
(Required)
Yes
No
Police Report Number:
Type of Loss:
(Required)
Hail
Wind
Tornado
Fire
Flood
Vandalism
Personal Injury
Description of Loss:
(Required)
Driver of Vehicle:
(Required)
Vehicle Involved:
(Required)
Type of Loss:
(Required)
Glass
Towing
Parked Vehicle
Collision
Hit and Run
Description of Loss:
(Required)
Location of the Loss:
(Required)
Driver of Other Vehicle:
Driver Information:
Police Contacted?
(Required)
Yes
No
Police Report Number:
Δ
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