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Submit a Claim - Preliminary Information


If you prefer online reporting, or if you should need to file a claim during nights, weekends, or holidays, here are links to online claim reporting services for our insurers.

Safeco.com

Arbella Insurance Group

If you have a claim during normal business hours, please call us, we are happy to help! you can also fill out this form



Claim's category: :  

Enter Fullname (Firstname, Lastname):  

Enter your email:        

Phone Number:    

Date of the accident:  

Time of the accident:  

Policy Holder (Insurance's name):  

Enter your policy number:  

The status of the policy:  

Vehicle Plate No:  

Do you have the police report of the accident?:  

Injury and Hospital Report:  

Were you at fault?  

Brief explanation of the accident