Fodor Companies
 
3308 Lorain Avenue
Cleveland, Ohio 44113
 
216.631.0116
REPORT A CLAIM
INSURED INFORMATION...
(* denotes required field)
Policy Holder's Name:
  *
Your Name:
  *
E-Mail:
   
Residence Phone:
 *
Mobile Phone:
   
Business Phone:
   
Fax:
   
Street Address:
        
P.O. Box/Suite:
          
City:
          
State:
          
Zip Code:
          
  LOSS INFORMATION...
 
Date of Loss:
Time of Loss:
 
Type of Loss:
(Auto, Property, Liability, etc.)
 
Location of Loss:
(location of Accident or Property)
 
Police Department (optional):
 
Police Report Number (optional):
     
    If Auto, Provide the following for the Policy Holder's Vehicle....
 
Name of Driver:
Vehicle:
  OTHER PARTY INFORMATION...
 
Name:
 
Residence Phone:
Business Phone:
Mobile Phone:
 
Street Address:
 
P.O. Box/Suite:
 
City:
State:
Zip Code:
     
 
Insurance Company (optional):
Policy Number (optional):
   
 
Vehicle:
License Plate#:
  SUPPLEMENTAL DETAILS...
 
Description of Claim:
    SEND AN E-MAIL COPY OF THIS CLAIM NOTICE TO...
 
E-mail Address #1:
E-mail Address #2:
 
 
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If you do not receive confirmation, please contact Fodor Companies at 216.631.0116.
 
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