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 Property Loss Notice 
Property Loss Notice

Contact Information
Your Full Name:
(as listed on policy now)
Your Email Address:
Daytime Telephone Number:
Description of Loss
Time & Date of Loss:
 Time AM PM
Date
Location:


Description of Loss:
Police or Fire Department:
Notified?
 Yes No
If Yes, Please Specify:

Is Property Habitable?:
 Yes No
If No, Where Are You Staying:
or Planning to Stay?
(Please include Address &
Telephone #'s you can be reached at):
Mortgagee or Bank Information

Please Note: Submitting this form via the website does not constitute a "formal" claim. Please contact us or your insurance company to notify of a loss.

Enter the security code you see above. Code is NOT case sensitive.*
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Insurance That Grows With You

Klemme Insurance Services, LLC
3211 W. Wadley #20
Midland, TX 79705

Toll Free: (866) 518-5646
 Phone: (432) 687-5646      fax: (432) 684-4428
 email: bob@klemmeinsurance.com  

READ OUR PRIVACY STATEMENT

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