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Formerly Galen Smith Insurance
   
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  Home Owners     Auto     Life - Disability
   Homeowners Insurance - Report a Claim
To report a claim by phone, please visit our Contact page.
   
Policy Number:
Your Name:

Contact Person:
Whom should the adjuster call to settle your claim?
Name:
Home Phone:
Work Phone:
Email Address:
Best Time to Call:


Authority Contacted:
Police/Fire Dept:
Report Number:


Claim Information:
Date of Loss:
Location of Claim:
Cause of Loss:


Describe Your Damage/Loss:
Emergency Services Needed:
Temporary Shelter Required?
Windows Required Boardup?
Other?


Persons Injured:
Name/Address:
Phone Number:
Nature of Injuries:
Cause of Injuries:


Comments and/or other Information:
 

 
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