home
contact us
site map
 
 
 
About Us
Employer Group Insurance
Business Insurance
Individuals
Apply Online
Financial Services
Resources
Healthcare Reform
 
 

Employer Access

Get Social With Us...

   

Calendar of Events

 Auto Loss Notice 
Automobile Loss Notice

Contact Information
Your Full Name:
(as listed on policy now)
Your Email Address:
Daytime Telephone Number:
Description of Loss
Time & Date of Accident/Claim:
Time AM PM
Date
Location of Accident:


Description of Accident:
Police Notified?:
Yes No
Were you ticketed?:

Yes No

If you received a ticket, what was it for?:
Driver Name:
Any Additional Information Not Requested Above
Please Note: Submitting this form via the website does not constitute a "formal" claim. Please contact us or your insurance company to notify of a loss.

    King and Companies
    150 E Travelers Trail, Suite C 
    Burnsville, MN 55337

     Toll Free: 877.374.5959 
     Telephone: 952.746.5959
     Fax: 952.746.5819

    © King and Companies, 2012 Powered By: Insurance Web Designs   webmail login