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Insured Name
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First
Last
Insured Email
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Policy Number (If you don't know it, just hit continue)
Is this for a new claim or existing?
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New Claim
Existing
Is everyone OK? Are there any injuries?
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Everyone is ok, no injuries
Everyone is ok, minor injuries, no one went to hospital
Injuries involved
N/A (Roadside Assistance)
What was the claim on?
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Auto
Homeowners
Renters
Toy (Motorcycle, RV, Boat, etc.)
Other
What happened with the auto claim?
(Required)
Collision (Someone Hit You)
Collision (You hit someone/something)
Comprehensive (Hit a deer, tree fell on car, etc.)
Car Stolen
Car hit while parked (on street, parking lot, etc.)
Roadside Assistance
What happened with the Home/Renters Claim?
(Required)
Fire
Theft
Water leak
Animal Bite
Other
Did you get a police report?
(Required)
Yes
No
What happened with the accident/Additional Details?
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What help do you need with your claim?
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