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231 Hudson Avenue   •   Newark  OH  43055
(740) 345-1916   •  (740) 345-3031   •  Fax: (740) 345-3031

   
On-Line Service Center

 Auto Insurance - 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.

If more than 2 people are involved, please call our agency directly to report the claim.
Policy Number:
Your Name:
Contact Person:
Whom should the adjuster contact about repairs?
Name:
Home phone:
Work phone:
Email address:
Authority Contacted:
Police department:
Report number:
Claim Information:
Date of loss:
Location of claim:
Cause of loss:
Describe, if other cause of loss:
Your Damaged Car:
Year/Make/Model:
Driver's name/address:
Driver's phone number:
Describe your damage:
Where is your car now?
Persons Injured:
Name and address:
Phone number:
Nature of Injuries:
Describe Other Car:
Year/Make/Model:
Owner's name/address:
Owner's PH#
Driver's name/address:
Driver's phone number:
Describe damage:
Insurance agent/company:
Describe What Occurred:
Comments and/or Other Information
           
If you have not received a response from us within one business day, please contact us again.  Thank you. 


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Campbell Agency, Inc. 
231 Hudson Avenue
Newark, OH 43055 
Phone:  (740) 345-1916
Phone:  (740) 345-3031
Fax: (740) 345-3031 

Copyright © Campbell Agency, Inc., 2003
campbellinc@adelphia.net