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Form Section 1
General Liability Claim Form
You will be contacted in 24-48 hours regarding your claim
Location of Incident (include street number, landmarks, or nearest intersection)
Date and Time of Incident
Tell us what happened
Was anyone injured?
Describe your vehicle: Year, Make, Model
Describe Vehicle Damage
Describe Property Damage
Witness Name / Phone # (if applicable)
Police Report Number (if available)
Upload estimate, invoice, and/or photos
Please provide Name and Phone Number of any other person or department with whom you have been in contact.