Report a Claim

To report a claim to the Agency please complete and submit the following form.

To report a claim please supply the following information:
(required for all claim reports)

Name
Title (if applicable)
Company (if applicable)
Type of Business (if applicable)
Mailing Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Phone
FAX
E-mail
URL (if applicable)
Comments

CLAIM REPORT

Type of Claim:

Please describe claim:

Please review the above information before submitting your claim.

E & K Agency, Inc. is licensed in the states of NJ, NY, PA, CT, FL, MA, GA, MO, NC, TN, TX & IA. This website is only intended for the use of residents in these states, and is not intended as a solicitation or offer of insurance in any other state or where such offer would be a violation of law.