Formerly Lineman Agency
Formerly Galen Smith Insurance
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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?
Yes
No
Windows Required Boardup?
Yes
No
Other?
Persons Injured:
Name/Address:
Phone Number:
Nature of Injuries:
Cause of Injuries:
Comments and/or other Information:
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