Commercial Claim Report Form
Please fill out the following Commercial Claim Report Form. Please note that coverage changes will NOT be in effect until you receive confirmation from our office. Asterick (*) denotes a required field.
Contact Information
Business Name
Contact Name*
Email*
Insured by
Petersen & Associates?*
Yes
No
Policy Number
Date of Loss*
Description
of Loss
Contact Information
Contact Name
Address
City
State
Zip Code
Home Phone
Work Phone
Best Place
to Contact*
Work
Home
Email
Best Time
to Contact
Note: Coverage changes will NOT be in effect until you receive confirmation from our office.
Thank You!
Thank you for filling out our online Commercial Claim Report Form. You will be contacted regarding this claim.