Report A Claim

Please complete the form below and we will contact you regarding your claim.

Filling out and submitting this form does not constitute a claim being filed, a representative of Marshall Insurance will contact you to finalize the process.

Policy Information:

Insured Name: Required

Insured Phone: Required

Insured Email Address:

Name of Person Reporting Claim: Required

Contact person for the claim: Required

Contact person for claim's phone number: Required

If contact person is different than the insured, what is the relationship to the insured?

Insurance Company: Required

Policy Number: Required

Type of Claim: Required

When is the best time to contact you? Required

Claim Information

Date of Loss: Required

Describe what happened: Required

Report A Claim

Policy Information:

Claim Information

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