Forrest Sherer Insurance | Terre Haute, Indiana

DID YOU KNOW?
You can notify us online if you have an insurance claim.

Click here to start
the process.

Business Loss Claim

NO COVERAGE OF ANY KIND IS BOUND BY SUBMITTING INFORMATION VIA THIS ONLINE FORM. Completion of this form does not constitute an actual claim, but serves to notify your agent of an existing loss or claim. By completing this form, you are acknowledging your understanding of and agreement with these terms

Your full name: (as listed on policy now)
Your email address:
Daytime telephone number:
Description of Loss:
Time & date of accident/claim:	Time AM PM Date
Location:
Type of accident/claim:	Property Liability Automobile Workers comp Other:
Description of loss:
Name(s) of injured parties:
Vehicle description (applicable to auto claims Only):
Driver name (applicable to auto claims only):

Any additional information not requested above:

Additional information will be requested upon receipt of this notice.