Commercial Auto Accident Claim

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Step 1

Verify that everyone is safe. Check for injuries, when in doubt, please dial 911.

Step 2

Do not discuss the incident with other parties. Limit your discussion of the incident to the police and your insurance agent. Do not admit fault.

Step 3

Write down contact information for all parties involved. Include names, phone numbers, and insurance information. In addition to contact information write details about the incident.

Step 4

If your phone has a built in camera, take pictures to perserve the scene for later review.

Step 5

Use the following form to notify us of the commercial auto accident claim.
Personal Information

First Name

Required

Last Name

Required

Street

Required

City

Required
State
Required

Postal Code

Required

Phone

Required

Alternate Phone Number

Optional

E-Mail

Required

Policy Number

Required
Incident Overview

What date did the incident take place?

Required

What vehicle was involved?

Required

How severe was the damage?

Required

Is the vehicle drivable?

Required

Was another vehicle involved?

Required

Where is the vehicle currently located?

Required

What is the phone number for the location?

Optional
Incident Location

Street Address

Optional

City, State. ZIP Code

Optional
Incident Description

Describe the incident.

Required

Code

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Verify

Required
Important Notice
Any 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 contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.