Claims

Property Claim Form

We will be happy to assist you with your property damage claim. All you need to do is fill out the brief form below, then click "Submit Request" at the bottom. One of our agents will personally review your information and contact you promptly about the claim.

Entries marked with an asterisk (*) are required.

Your name:*

Insured Information

Insured's name:*
Street address:*
City:*
State:*
Zip Code:*

Loss Information

Date of loss:*	(mm/dd/yyyy)
Location of loss:*
Description of loss:*
Authority contacted: (If a theft, must be reported to police)
Insured getting estimates?:*	Yes No

When to Report Claim

Report claim:*

Now Wait for estimates

Contact Information

Please contact me via (select one or more options):*
Phone (include area code):
FAX (include area code):
E-Mail:
Postal mail:
Street:
City:
State:
Zip:

Other

Questions, comments, or special requests:

Submit Request

NOTE:

The information you submit will be transmitted from this Web site to our staff via email through the Internet. Additionally, information you enter will be transmitted from your computer to our Web site in un-encrypted form. We believe that this transmission is unlikely to be intercepted, but we cannot guarantee privacy of the information you submit while it is passing through the Internet. If you do not wish to submit this form from the Web, please feel comfortable contacting us by telephone, FAX or other postal mail, and we will be happy to respond to you in that way.

Contact Us

FirstChoice Insurance Agency, Inc.
338 Pearl Ave.
Oshkosh, WI 54903-0766
(920) 235-3450, Toll free: (800) 368-7536, FAX: (920) 232-8731
E-Mail: mail@firstchoiceinsurance.biz