Lanza Insurance Agency - Claim Starter

Claim Starter

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Welcome to the property and Casualty Claim Starter form. Please follow the instructions to complete the necessary information on-line. When you are finished the form will be forwarded to the claim department. A claim service representative will contact you to discuss the details and explain the claim process.



* Required Field

1. Claim Information

Is this a personal or a business claim?


Personal Claim Business Claim

Please select the type of claim.

Automotive Home/Building Bodily Injury/Property Damage Worker's Compensation Other
Other, explain:

Are you insured with Lanza Insurance Agency?





2. Personal Information

Name*:
Address*:
City*:
State*:
Zip Code*:
Phone Number*:	(xxx-xxx-xxxx)
Email Address:



Best to Contact Via*:

When to Contact*:



3. Additional Information

Date of Loss*:
Location of Loss (City/State)*:
Reported to Authorities?*:



Loss Description*:
Damage Description:
Injury Description:



4. Additional Comments