Agent Login
E-mail / User Name:
Password:
Remember me on this computer.
Forgot your password? Click here.
Fill in the form below for an online claim report. Be sure to fill out all of the requested fields and a representative will get back to you promptly. After completing the form, press the Submit button.
Contact Information
Policy Holder's Name:
Policy Number:
Primary Contact Phone#:
Secondary Contact Phone#:
E-Mail Address:
Claim Information
Incident Date:
Incident Time:
Location of Incident:
Was anyone injured?
Yes
No
Police Dept. Contact:
Investigation Agency Report #:
Description of what occured:
Description of damages:
Damaged Vehicle Info
Were any vehicles damaged?
Yes
No
Submit your claim by clicking "Submit" below.
NOTE:
Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
1-800-392-9966 |
Contact Us
©
2010
Granada Insurance Company