Property Loss Report - Claim Report - Brown & Brown Garden City

Please use this form to submit a Property Loss Report - Claim. For immediate assistance please call us at 516-745-0000 or Toll Free at 800-221-2834.

Company Name (if applicable)

Your Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Email

Location of Loss

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Police Precinct or Fire Dept Report Number

Description of Loss

Were there any injuries or damage to adjacent property? If YES, please describe

PLEASE NOTE: No claim can be considered reported until you receive written confirmation from this office or the insurer.