Claims

If you have a claim to report, you can take advantage of the insurance carriers' 24/7 Claim Support Service to report a claim directly to the insurance company claim department

Please complete the form below

Name of Party Reporting Claim

First Name

Last Name

Name of Business

If applicable

Email Address

Phone

(###)

###

####

Policy Number

Name of Insurance Provider

Claim Date

MM

DD

YYYY

Claim Time

When did this occur?

Hour

Minute

Second

Detailed Description of Claim

Disclaimer

I understand that insurance coverage is not bound or altered until I receive confirmation by an authorized representative of Broad Spectrum Insurance Services