X-Y-Z Insurance Agency, Inc.

650 South Front Street • Suite 600 • Columbus OH 43206
(614) 445-5555 • (800) 445-7777 • Fax: (614) 445-7777

On-Line Service Center

Report a Claim

Please note: Submitting a claim at this web site does not confirm
coverage or authorize payment. A claims representative will verify
coverage and contact you to complete the claims process.

Type of Policy:

Policy Number:

Your Name:

Contact Person:
Whom should the adjuster call to settle your claim?

Name:
Home Phone:
Work Phone:
E-Mail:
Best time to call:

Authority Contacted:

Police/Fire dept:
Report number:

Date of loss:

Description of loss:

Comments and/or Other Information:

If you have not received a response from us within one business day, please contact us again. Thank you.

Return To Service Center Forms Page

X-Y-Z Insurance Agency, Inc.
650 South Front Street
Suite 600
Columbus, OH 43206
Phone: (614) 445-5555
Toll Free: (800) 445-7777
Fax: (614) 445-7777

Please note: Submitting a claim at this web site does not confirm coverage or authorize payment. A claims representative will verify coverage and contact you to complete the claims process.

If you have not received a response from us within one business day, please contact us again. Thank you.

Please note: Submitting a claim at this web site does not confirm
coverage or authorize payment. A claims representative will verify
coverage and contact you to complete the claims process.