Auto Claim Form (Ehlers)
Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.
Are you currently working with someone within our Agency *
If any injuries, please explain who and brief description of injuries.
What date did the incident take place? *
Was another vehicle involved? *
How severe was the damage? *
Is the vehicle drivable? *
Any other information from other party or police report? *
submissions or payments made via this website do not constitute a
binding agreement to your policy or coverages. Changes and
payments to policies are not effective or binding until you, or any
party involved, receive official notice from either your insurance agent,
or your insurance company. If you have any questions, please feel free to
Per the terms of our
we will not resell your information to any third-party.