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Report an Auto Claim
If more than 2 people are involved, please call our agency directly to report the claim.
Policy Number:
Your Name:
Best way to contact me: Please have a licensed agent contact me to gather the required information.
I am completing the information requested below, please have a friendly licensed agent contact me.
Contact Person:
Whom should the adjuster contact about repairs?
Name:
Home phone:
Work phone:
Email address:
Authority Contacted:
Police department:
Report number:
Claim Information:
Date of loss:
Location of claim:
Cause of loss:   
Describe, if other cause of loss:
Your Damaged Car:
Year/Make/Model:
Driver's name/address:
Driver's phone number:
Describe your damage:
Where is your car now?
Persons Injured:
Name and address:
Phone number:
Nature of Injuries:
Describe Other Car:
Year/Make/Model:
Owner's name/address:
Owner's PH#
Driver's name/address:
Driver's phone number:
Describe damage:
Insurance agent/company:
Describe What Occurred:
Comments and/or Other Information
           
If you have not received a response from us within one business day, please contact us again. Thank you.
 
Babbitt-Sholund Insurance  201 E. Bell Street, Neenah, WI  54956  •  Phone: (920) 722-7531  Toll Free: (800) 236-8600
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