Personal Auto LOUIS A WILLIAMS Customer Services


To report a claim: Call 800-256-5291 ext 311 or report claim electronically by completing form below.

Person Reporting the Claim
 
Your First Name: *
 
Your Last Name: *
 
Are you the:
Insured   Other Party   Neither   Explain:

 
Your Cell Phone#: *
 
Other Contact Phone#:
 
Your Email Address: *
 
Your Address: *
 
Your City, State & Zip: *
   

Insured Information

 
Policy Number:
 
Insured's First Name:
 
Insured's Last Name:
 
Insured's Cell Phone#:
 
Other Contact Phone#:
 
Driver's First Name: *
 
Driver's Last Name: *
 
Driver's Phone#: *
 
Insured Vehicle: *
 
Describe Damage: *

 
Was vehicle towed?
Yes   No   If towed, where is vehicle?
 
Describe Injuries: *

Other Vehicle in Accident

 
Driver's First Name:
 
Driver's Last Name:
 
Driver's Cell Phone#:
 
Driver's Other Phone#:
 
Vehicle Description:
 
Describe Damage:

 
Was vehicle towed?
Yes   No   If towed, where is vehicle?
 
Describe Injuries:

 
Other party insurance co and policy number if known:




Other Important Information

 
Date of Accident: *
   Time of Accident: *
 
Accident Location: *
 
Describe what happened: *

 
Was there a police report? *
What authority was contacted? Case #: Citations:


 
Additional Information:

Upload a photo of damages.

On submit look for success message to verify e-mail was sent.
If no success message limit amount of pictures to 4 or less.