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.

Also in Claims

FORREST SHERER
CLAIMS CENTER
24 N. 6th St.
Terre Haute, IN

If you have a claim and are having difficulty contacting your carrier, please contact us.
ph. 812.232.0441
fax 812.232.0926

If you prefer, report your claim to our office by clicking here.


   
careers    privacy/legal
Forrest Sherer Insurance, 24 N. 6th Street, Terre Haute, Indiana 47807 - 812-232-0441