Burlington Claims - Hickok & Boardman Insurance Group

City of Burlington Claims Reporting: Property

Your Name
First Last
Phone
Your email address*
Enter Email Confirm Email
Claim Contact Person
Contact Name
First Last
Contact Phone
Contact Email*
Enter Email Confirm Email
Dept Supervisor
First Last
Department
Time & Place of Accident or Loss
Date
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
Location
Street Address Address Line 2 City State ZIP Code
Estimated Repair Costs
Building and / or Contents
Decribe Cause of Loss
Additional Details
Boiler & Machinery
Describe Details of Loss
Robbery & Theft
Were Police notified?
- Yes
- No
Explain
Was Culprit Apprehended
- Yes
- No
Explain
Decribe the situation below
Phone
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