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Claims Information

When you need us most, the last thing you want is a difficult, drawn out claim process. That's why CAIS is different ... we strive to make it easy to file insurance claims.

* indicates required fields

Report a Claim

Contact Information

Name of Person Reporting Claim *

Phone*

Email Address*

Check here if the Reporting Person is the same as the Contact Person

Name of Person to Contact *

Phone*

Email Address*

Policyholder Name (Individual of Company) *

Policyholder Street Address *

Policyholder City *

State*

Zip*

Additional Comments or Questions

Loss Location

Check here if the Loss Location is the same as the Policyholder Location

Loss Location Street Address *

Loss Location City *

State*

Zip*

Description of Loss

Date of Loss*

Type of Loss

Description of Loss

Claimant Name *

Phone*

Email Address*

Has a Police Report been filed? Yes No

If Yes, Police Department *

Case Number *

Estimate of Loss*

Suit Information

Has Suit been filed? Yes No

If Yes, Date Served*

Attach Files