Report a Claim

Please fill out the information below and attach any photos or documents. We'll get your claim started right away.

YOUR INFORMATION

Insured Name

Policy Number (if you have it handy)

Phone Number

Email Address

Mailing Address

TYPE OF CLAIM

What type of claim are you reporting?

LOSS DETAILS

Date of Loss

Approximate Time

Location of Loss (address or intersection)

Police / Fire Report # (if a report was filed)

Description of What Happened (please be as detailed as possible)

AUTO CLAIM DETAILS

Complete this section if your claim involves a vehicle.

Year, Make & Model

VIN # (check your insurance card or registration)

Driver at Time of Loss

Damage & Location on Vehicle

PROPERTY / HOME CLAIM DETAILS

Complete this section if your claim involves your home or property.

Property Address (if different from mailing address)

Describe the Damage

Is the Home Still Livable?

Emergency Repairs Needed?

OTHER PARTY INFORMATION

Complete this section if another person or vehicle was involved.

Other Party Name

Other Party Phone

Other Party Address

Other Party Vehicle (year, make, model)

Damage to Other Vehicle / Property

INJURIES & ADDITIONAL INFORMATION

Were There Any Injuries?

Additional Notes or Questions

📷 PHOTOS & DOCUMENTS

Upload photos of damage, the accident scene, police reports, or any other relevant documents. You can upload multiple files.

Photos of Damage

📸

Click to upload photos

JPG, PNG, HEIC — up to 10 photos

Police Report / Other Documents

📄

Click to upload documents

PDF, DOC, JPG, PNG

Your claim information and uploaded files will be sent directly to
Sharon at Powell & Meadows. We'll be in touch shortly!

Powell & Meadows Insurance Agency

Carthage • Gallatin • Lebanon • Lafayette • Portland

Text: (615) 588-0106 | Call: (615) 735-1111