File A Claim

Boat/Motorcycle and Other Speciality Lines Quote Information Request

Contact Information
Name*
First Last
E-mail*
Phone*
Best contact method
- E-mail
- Phone
Insurance Needs - Please contact me regarding*
- Motorcycle Insurance
- Boat / JetSki Insurance
- Classic Car Insurance
- RV / Motorhome Insurance
- Off-Road Vehicle Insurance
- Other
Comments
Binding Agreement*
- I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.

Get a Workers Comp Insurance Quote

To receive a quote for workers comp insurance, fill out the information below and we'll get back to you right away with a competitive quote. Required fields are marked with: *

Business information
Business name*
Business type
- Corporation
- LLC
- Partnership
- Sole proprietorship
Contact information
Contact name*
First Last
Address*
Street Address City State ZIP Code
Phone*
E-mail*
Fax
Website
Additional information
Years in business
Do you have employees or uninsured subcontractors?
- No
- Yes
Annual payroll for all employees and subcontractors
Would you like the quote to include coverage for the owner/officer?
- No
- Yes
Effective date of coverage
The date you would like coverage to begin
Comments
Binding Agreement*
- I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.
We respect your privacy. Your information will be sent securely and handled with care.

Life-Health-Umbrella Quote Request Form

Contact Information
Name*
First Last
E-mail*
Phone*
Best contact method
- E-mail
- Phone
Insurance Needs - Please contact me regarding*
- Health Insurance
- Life Insurance
- Umbrella Insurance
- Other
Comments
Binding Agreement*
- I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.
We respect your privacy. Your information will be sent securely and handled with care.

Get an Auto Insurance Quote

To receive a quote for auto insurance, fill out the information below and we'll get back to you right away with a competitive quote. Required fields are marked with: *

Personal information
Your name*
First Last
Address*
Street Address City State ZIP Code
E-mail*
Phone*
Occupation*
Vehicle information
Add multiple vehicles*
Year Make Model
Add VIN for vehicles
VIN
Vehicle uses*
- Business
- Pleasure
- School
- Work
Education*
Owner information
Name on title*
First Last
Purchase date
Ownership*
- Lease
- Loan
- Own
Loan/lease company
Current Auto Insurance
- I currently have an Auto insurance policy
Insurance Company
Expiration Date
Address
Street Address Address Line 2 City State ZIP Code
Driver information
Drivers names*
First Last
Social Security Numbers
Drivers license numbers*
Dates of Birth*

MM/DD/YYYY
Annual mileage
miles (estimated)
- One or more drivers (under 18 years old)
- Has completed driver training
- Qualifies for the good-student discount
Coverage information/Coverage type
- Best coverage
- Lowest deductible
- Lowest rate
- State minimum
- Other
Coverage description
Coverage options
- Gap / replacement cost
- Medical payments
- Rental reimbursements
- Towing & roadside assistance
Would you be interested in an Umbrella Insurance Quote?*
- Yes
- No
Comments
Binding Agreement*
- I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.
We respect your privacy. Your information will be sent securely and handled with care.

File a Homeowner's Claim

PLEASE FEEL FREE TO CONTACT US DIRECTLY AT 270-554-2105 DURING BUSINESS HOURS TO FILE YOUR CLAIM. WE ARE HERE TO HELP AND ASSIST YOU THROUGHOUT THIS DIFFICULT PROCESS. ANY QUESTIONS OR CONCERNS YOU HAVE MAY BE DIRECTED TO OUR OFFICE CLAIMS DEPARTMENT. Required fields are marked with: *

Personal Information
Name on policy*
First Last
Policy number
Best Form of Contact*
- E-mail
- Phone
- Fax
E-mail*
Phone*
Fax
Date of Loss*
Description of Damage to Property:*
Claim Status Acknowledgment *
- I understand that the submission of my claim is not complete until the information has been confirmed by one of our representatives by phone or email.
Homeowner Claims - What To Do Right Now
1. Make whatever temporary repairs are needed to avoid further damage.

2. Notify your agent of the situation. Keep in mind that your deductible would apply. Sometimes it is preferable to get an estimate for the damages prior to submitting a claim if the damage might be lower than the amount of your deductible.

3. If the problem occurs after normal business hours and needs immediate attention, contact the your company directly via the information listed on your policy package.
What To Expect After a Home Insurance Claim is Reported
1. Once the claim is reported to the company, a claim number and adjuster will be assigned.

2. The adjuster will try to make an initial contact with you within 24 to 48 hours to discuss what the damages are and what the next steps will be.

3. If the damages need to be inspected, the claim will be assigned to an outside adjustor who will call and schedule an appointment with you. If there has been a major storm and if the damage is exterior only, it is possible that a drive-by inspection will be done.

4. In the event of a major storm, insurance companies do have "catastrophe" procedures in place. Adjustors from other areas of the country are brought in and extra telephone lines may be added. Depending on the severity, your claim might take more time than a normal situation, and your patience is appreciated.

5. Claim checks are mailed to you for the damages less your deductible. Please note that if the damage is substantial, the check might be payable to you and your mortgage company.
We do recommend that you keep an inventory of your personal property. This information can be valuable in the event of a loss. If you would like a copy of an inventory guide, please contact us with your request.

Auto Change Request Forms - Update Driver Info

Required fields are marked with: *

Personal Information
Name on policy*
First Last
Policy number
Confirm by*
- E-mail
- Phone
- Fax
E-mail*
Phone
Fax
Driver information
Driver's name*
First Last
Driver's license number*
Comments
Binding Agreement*
- I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.
We respect your privacy. Your information will be sent securely and handled with care.

Auto Change Request Forms - Add a Driver

Required fields are marked with: *

Personal Information
Name on policy*
First Last
Policy number
Confirm by*
- E-mail
- Phone
- Fax
E-mail*
Phone
Fax
Driver information
Driver's name*
First Last
Date of birth*
Date Format: MM slash DD slash YYYY
Driver's license number*
- This is a young driver (under 18 years old)
- Has completed driver training
- Qualifies for the good-student discount
Vehicle driven primarily*
Comments
Binding Agreement*
- I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.
We respect your privacy. Your information will be sent securely and handled with care.

Auto Change Request Forms - Remove a Vehicle

Required fields are marked with: *

Personal Information
Name on policy*
First Last
Policy number
Confirm by*
- E-mail
- Phone
- Fax
E-mail*
Phone
Fax
Vehicle information
Year*
Make*
Model*
Coverage information
Effective date
Comments
Binding Agreement*
- I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.
We respect your privacy. Your information will be sent securely and handled with care.

Other Policy Change Request Form

Required fields are marked with: *

Personal information
Name on policy*
First Last
Policy type*
Policy number
Confirm by
- E-mail
- Phone
- Fax
E-mail*
Phone
Fax
Comments
Binding Agreement*
- I understand that coverage cannot be bound or altered until the information has been confirmed by one of our representatives by phone or email.
We respect your privacy. Your information will be sent securely and handled with care.

Order Auto ID Cards

If you've lost your auto policy ID cards, or if you just need more copies, fill out the form below and we'll get you what you need. Required fields are marked with: *

Personal information
Name on policy*
First Last
Policy number
Number of cards*
E-mail*
Fax
Address
Street Address City State ZIP Code
Vehicle requested
Send my card by:*
- E-mail
- Fax
- Mail Address
Comments
We respect your privacy. Your information will be sent securely and handled with care.

Year	Make	Model

VIN

First	Last

File a Homeowner’s Claim

File an Auto Claim

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What To Expect After an Auto Claim is Reported

Personal Information

Homeowner Claims - What To Do Right Now

What To Expect After a Home Insurance Claim is Reported

Personal Information

Driver information

Personal Information

Vehicle to remove

Vehicle to add

Owner information

Personal Information

Driver information

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Vehicle information

Coverage information

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Vehicle information

Owner information

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