Report an Insurance Claim

Name*
First Last
Email*
Phone*
Claim Type*
- Business
- Personal
Business Name*
Type of Loss*
- Auto
- Property
- Workers Compensation (Employee Injury)
- Other
Date of Accident/Loss*
MM slash DD slash YYYY
Time of Accident*

: Hours

Minutes

AM/PM
Address of Accident*
Street Address Address Line 2 City State ZIP Code
Upload Attachments:
Drop files here or

Max. file size: 512 MB.
You can upload one or multiple pictures or documents to help us with your claim service.
Description of Accident*
Additional Comments/Special Instructions
DISCLAIMER:*
- I Understand
Claim information entered into this form goes directly to East Bridgewater Insurance, and not your actual insurance carrier. To report a claim directly to your insurance carrier, visit our Carriers and Partners page to find a link to your insurance carrier’s website.
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