Auto Accident Claim Form
What to do in the event of an Auto Accident
- Make certain you and your passengers are safe – move your vehicle off the road and turn on your hazard lights.
- Call 911 if there are injuries or the accident is significant
- If you are witnessing road rage from the other party, keep your distance from them and call 911.
- Information on the Other driver’s Insurance Card, including
- Insurance Company details, including (name, policy number and Ph. Number).
- If the other driver can not furnish the information, call 911 and obtain their License Plate Number and any information you can on the vehicle.
- Call our Agency, your Insurance Company or complete the form below – if you call the Insurance Company, please let us know when you have a moment so we can monitor the claim.
What date did the incident take place? *
Was another vehicle involved? *
How severe was the damage? *
Is the vehicle drivable? *
Other Drivers Informaton (e.g. Name, Phone #: etc.)
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
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we will not resell your information to any third-party.