Campbell Agency, Inc.

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

On-Line Service Center

Homeowners 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.

Policy Number:

Your Name:

Contact Person:
Whom should the adjuster call to settle your claim?

Name:
Home Phone:
Work Phone:
E-Mail:
Best time to call:

Authority Contacted:

Police/Fire dept:
Report number:

Claim Information:

Date of loss:
Location of claim:
Cause of loss:

Describe Your Damages/Loss:

Emergency services needed:

Temporary Shelter Required? Yes No
Windows Required Boardup? Yes No
Other?:

Persons Injured:

Name/address
Phone number:
Nature of injuries:
Cause of injuries:

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