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Report a Homeowner 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 call to settle your claim?
Name:
Home Phone:
Work Phone:
E-Mail:
Best time to call:
Authority Contacted:
Police/Fire dept:
Report number:
Claim Information:
Date of loss:
Location of claim:
Cause of loss:
Describe Your Damages/Loss:
Emergency services needed: Temporary Shelter Required? Yes  No
Windows Required Boardup? Yes  No
Other?:                  
Persons Injured:
Name/address
Phone number:
Nature of injuries:
Cause of injuries:
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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