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Industrial Insurance Agency
Industrial Insurance Agency Client Services
Serving the Chicagoland and the Midwest for over 40 years Serving the Chicagoland and the Midwest for over 40 years
 

Industrial Insurance Agency

Online Report A Claim Form

This document will be forwarded to the Industrial Insurance Agency claim department. Our claims department staff will follow up with you on the next business day. It is our intent to assist you in any way that we can in the settlement of your claim.

Your Name:
Company:
(if a company car)
Daytime Telephone:
E-mail:
Kind of Loss:  Automobile
 Wind, Hail Damage
 Fire
 Burglary
 Workers Compensation
 Other (please describe below)
Date of Loss or Accident:
Where Did the Accident Occur:
Were There Any Injuries:  Yes
 No
Brief Description of Loss, Accident or Damage:
 


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