Property Claim Form

   Back to CLAIM FORMS Page Copyright 2000 [Thompson-Gusic Insurance Group, Inc.].  
ALL RIGHTS RESERVED

Property Claim Form

-   The "ENTER" or "RETURN" Key will submit the application.   Use the "TAB" Key and Mouse to navigate.
      If application is submitted by mistake, use the
"BACK" Button on your browser to return to the application. 

 
-  This form is intended for your "owned" Property Claims.  If your claim involves Property Damage to
    other's property you do not own, use the General Liability Claim Form.

Your Account Name:

 Phone:

City, State

State:

 Fax:

Person Completing Form:

 Email:
 WHO IS TO BE LEAD CONTACT FOR FURTHER INVESTIGATION OR CLAIM INFORMATION     SAME AS ABOVE
 Lead Contact Name:   Phone #:  Email:
 CLAIM INFORMATION
 Date of Claim Occurrence:   Time of Claim Occurrence: AM  PM
 Location of the Claim (address or specific area):
 Description of Loss and Damage that Occurred?
 If an authority such as police or was contacted, please name:
 What is the report # of the authority, if known:
 PROPERTY DAMAGED INFORMATION
 What kind of loss occured?  Fire Theft Lightning Hail Wind Storm Water Vandalism    
  Other:

 If applicable, have you secured the damaged property to mitigate further damage?   Yes   No
   If NO, please do so and keep all receipts for items / services purchased.

 Do NOT throw away damaged item(s).  Keep them in a secure place as the company may need to investigate or view item(s)
.
 AMOUNT OF DAMAGES
 Estimate Amount of Damages ($ Amount):  or   Unknown    Estimate is in Process of being completed

 
!!!  IMPORTANT  !!!
 
Supporting documents such as estimates or pictures can be faxed to (877) 271-8898 or (412) 271-8898, or
 emailed to insurance@thompsongusic.com
 

QUESTIONS / HELP

 

Office Email:

 insurance@thompsongusic.com

Office Phone:

 (412) 271-8888  (9 - 4:30 EST)   Out-of-State (PA): (888) 944-8398

Office Fax:

 (877) 271-8898

 

 CREATED 6/00 by
T.R.G.
Copyright 2000 [Thompson-Gusic Insurance Group, Inc.].  ALL RIGHTS RESERVED
Revised: July 14, 2016 .