Welcome to Insurance-Quotes.net, the Internet home of Pfeifer-Ornstein Insurance Agency, LLC.

the smart source for all your insurance needs...

  

Report an Auto Insurance Claim:
If more than 2 people are involved, please call our agency directly to report the claim.

Your Name:

Policy Number:

Contact Person: Whom should the adjuster contact about repairs?

Name:
Home phone:
Work phone:
Email address:
Authority Contacted:
Police department:
Report number:
Claim Information:
Date occurred
Location of claim:
Type of incident:
 if other, describe:
Your Damaged Car:
Year/Make/Model:
Driver's name/address:
Driver's phone number:
Describe your damage:
Where is your car now?
Persons Injured:
Name and address:
Phone number:
Nature of Injuries:
Describe Other Car:
Year/Make/Model:
Owner's name/address:
Owner's PH#
Driver's name/address:
Driver's phone number:
Describe damage:
Insurance agent/company:
Describe What Occurred:
  
Comments and/or Other Information

Please Note: Insurance coverage cannot be bound without a written binder from our office.

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