Contact Us / Submit A Claim

Submit A Claim

Submit Claim

  • Tendering Party
    Your First Name*  
    Your Last Name*  
    Your Company*  
    Your Address*  
    City, State, Zip Code*  
    select
          		 
    Phone #*   ext.  Fax #
    Email*  
    Your Claim #
  • Insured
    Insured Information
    Insured Company Name
    Insured Last Name*  
    Insured First Name*  
    Policy Number*  
    Effective Dates*
    RadDatePicker
    Open the calendar popup.
    		to
    RadDatePicker
    Open the calendar popup.
    Insured Address*  
    City, State, Zip Code*  
    select
          		 
    Phone #*   ext. 
    Secondary Phone #   ext. 
    Email
  • Claimant
    Claimant Company Name
    Claimant Last Name
    Claimant First Name
    Claimant Address
    City, State, Zip Code
    select
    Phone # ext. 
  • Assignment
    Type of Assignment
    select
     
    Loss Description  
    Date of Loss/Accident
    RadDatePicker
    Open the calendar popup.
    Loss Location
    Address *  
    City, State, Zip Code*  
    select
    Assignment
  • Attachments
    Attachment Info To attach your documentation, click Browse Files.
    *Acceptable File Formats: jpeg , jpg , gif , png , bmp , tiff , tif, pdf, doc, docx, xls, xlsx, txt, wpd
  • Verification
    Verification Info

Blair & Company is focused on helping clients solve their claims handling needs. Contact Us!