Grain Dealers Mutual

File A Claim

For Emergency After Hours Service, Call (toll free) 1.877.974.5277

After suffering a loss, returning everything "back to where it belongs" is important. This option allows you to notify us of a claim. A convenient way to get the claim process started; anytime, anywhere.

NOTE: Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.

Broken windshield? If you are reporting an auto glass loss, please select this option. For all other losses, please complete the form below.

	Your Name:
	Your email Address:
	Insured's Name:
	Policy Number:

	How do we contact our Insured (Phone/E-mail)?:

	What Happened?:

	If this was an auto accident, which vehicle was involved?:

	If this was a property loss, at which property location did the accident occur?:

When?:

	Where did it happen?:

City:

State:

	Remarks/Requests/Comments:

Include Attachments (as needed)

Files:

Remember! Losses needing immediate attention should be phoned into the nearest office listed below:

Offices:	Greensboro, NC	800.632.0301 (NC) or
		800.334.0260
	Indianapolis, IN	800.428.7081

For Emergency After Hours Service, Call (toll free) 1.877.974.5277