General Insurance Agency, Inc.
Report a Claim

Please provide the following contact information so we may contact you for additional information: (all information is required)

Contact First Name
Contact Last Name
Contact Title
Organization
Street Address
Address (cont.)
City
State
Zip Code
Station Phone	(xxx-xxx-xxxx)
Home or Cell Phone	(xxx-xxx-xxxx)
E-mail

Type of Claim: 

Portable Equipment Damage         Auto Accident        Building/Contents Damage        Theft of Money - Employee/Member
Theft of Money - Non-Member       Liability Claim      Member Injury/Death             Other                          

Please provide a description of what happened including date and approx. time it happened, vehicles, property or persons involved.

By submitting the above information, you are attesting that you are an authorized delegate of the organization to make notification of a claim, the above information is true and accurate and the contact information we have on file matches the information you are sending.  We will contact you for additional information.  If you need immediate assistance, please call Wes at 215-317-8414 or Tony at 570-764-6033 anytime, day or night.

Do not discard any damaged property until notified.

 

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General Insurance Agency, Inc.
Copyright © 2008 [General Insurance Agency, Inc.]. All rights reserved.
Revised: 11/22/08