Report A Claim

Please fill out the below form and/or call our claims department at (800) 328-8451 or (952) 238-2066.

*Required Fields.

Insured

Name*:

Address*:

Address Two:

City*:

State*:

Postal Code*:

Loss

Date of Loss: (Ex: 4/17/2024)

Month Day Year

Location of accident (Include city & state):

Description of accident:

Authority contacted:

Report #:

Violations/Citations:

Insured Vehicle

Serial Number:

Year:

Make:

Owner Information

Owners Name:

Address:

Address Two:

City:

State:

Postal Code:

Driver Information

Drivers Name:

Address:

Address Two:

City:

State:

Postal Code:

Phone Number:

Date of Birth:

Month Day Year

License #:

Describe Damage:

Cargo Damage:

Yes No

Describe Cargo Damage:

Submit

**If it is an emergency or after normal business hours please report directly to your insurance company by calling the 800 number provided on your Cab Card/Coverage Certificate

Report A Claim

Insured

Loss

Insured Vehicle

Owner Information

Driver Information

get truck insurance

the way you want it!