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Report A Loss - Automotive

* indicates required fields - To help us process the
claim as quickly as possible, please complete all
pertinent fields clearly and accurately.

* Named Insured:
Street:
City, State:
* Email Address:
* Home Phone:
Work Phone:
Driver's Name:
Vehicle:
Damaged Area:
Reporting Police Dept:
Report #:
Location of Loss:
Date of Loss:
Present Location of Vehicle:
Who was cited:
Type of Citation:


Owner's Name:
Street Address:
City, State:
Owner's Home Phone #:
Owner's Work Phone:
Driver's Name:
Vehicle:
Damaged Area:
Insurance Company:
Agent's Name:


Name #1:
Street Address #1:
City, State #1:
Contact Phone #1:
Name #2:
Street Address #2:
City, State #2:
Contact Phone #2:
Name #3:
Street Address #3:
City, State #3:
Contact Phone #3:

Description of Loss

Time and Date Now


or

24 hr. claim numbers.

EMC Insurance Company  888-362-2255

Hastings Mutual Insurance Company  800-442-8277

Cincinnati Insurance Company 877-242-2544

Auto Owners Insurance Company 888-252-4626

Ohio Mutual Insurance Company  888-895-7725

German Mutual Insurance Company 800-597-0140

Progressive Insurance Company  800-274-4499

 

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