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Submit Claim Information OnLine 

Online Claims Documentation/Information Submission

The general purpose for this Claims Documentation Form is to provide you with an easy to use way of supplying the claims process with a written description of exactly what happened, in your own words.

Providing this information does NOT replace the need for a claims adjuster to personally contact you.  It does however allow you to document, in great detail, what has occurred for your file and records within our office.

In the event of a natural disaster (i.e. tornado, flood, storm, fire, etc..) where basic services have been interrupted, this form further allows us to receive information from you that could otherwise be difficult to receive if our telephone lines were consistently busy due to the disaster. In such an instance try to remember how far reaching the Internet can be... If you can get to a computer with Internet access, you can quickly use this method to communicate your situation with us.

Please remember:

Always call first to report your claim

*  Indicates A Required Field

PLEASE PROVIDE YOUR INFORMATION
Your Full Name:
 *
Day Phone:
 *
Evening Phone:
 *
Email Address:
 *
 
Would you llike us to contact you?
 
If answer to prior question 'YES' - preferred method:
 
INSURANCE POLICY INFORMATION
 
Insurance Co. Name:
 *
Policy Number:
 *
Have you already spoken to company about claim?
If a company claim# has been issued enter below:
 
 
Claim Type:
Date Of Incident mm/dd/yy:
 *
Vehicle Involved (if any):
 
Please provide any witnesses / names / phone numbers (if applicable):
 
Incident Description:
Security code:
 *
Do not enter anything in this field:

* indicates a required field
 


'Blessed Insurance - Peace Of Mind'

Frank Steil Insurance Agency
4610 Hixson Pike
Hixson,  TN  37343
Phone: 423-875-2840

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