☰ ˟
Social Icon Social Icon Social Icon Social Icon Social Icon
CALL   |    EMAIL   |    TEXT
Logo
  • Home
  • Get A Quote
    • AutomobileImage of right arrow
      • Auto Insurance Quote
      • Auto Change Request Form
    • Business & CommercialImage of right arrow
      • Commercial Auto Insurance Quote
      • General Liability Quote Form
    • FloodImage of right arrow
      • Flood Quote Form
    • HomeownersImage of right arrow
      • Home Insurance Quote
    • LifeImage of right arrow
      • Life Insurance Request Form
    • MotorcycleImage of right arrow
      • Motorcycle Insurance Quote
    • Recreational VehicleImage of right arrow
      • Recreational Vehicle Insurance Quote
    • RentersImage of right arrow
      • Renters Insurance Quote
    • Umbrella
    • Watercraft & BoatImage of right arrow
      • Watercraft Insurance Quote
  • Policy Changes
    • Customer Service
    • Policy Renewal Review Form
  • Resources
    • View Our Blog
    • Important Links
    • Secure Area
    • Important Files
    • Refer a Friend
    • Calculators
    • Insurance Glossary
    • Frequently Asked Questions
    • News Center
    • Videos
  • About Us
    • About Us
    • Location Map
    • Employee Directory
    • Companies Represented
    • Partners Page
    • Testimonials
    • Privacy Policy
  • Contact
    • Contact Us
    • Join our Newsletter

What type of coverage do you need?
Home > Automobile > Auto Accident Claim
Secured by SSL

Auto Accident Claim


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name *
Last Name *
Street *
City *
State *
ZIP / Postal Code *
Primary Phone Number *
Alternate Phone Number
E-Mail Address *
Policy Number *
Incident Overview
What date did the incident take place? *
/ /
What vehicle was involved? *
Was another vehicle involved? *
How severe was the damage? *
Is the vehicle drivable? *
Where is the vehicle currently located? *
What is the phone number for the location?
Incident Location
Street Address
City, State. ZIP Code
Incident Description
Describe the incident. *
Submission Validation
Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
Secured by SSL
Insurance Websites Designed and Hosted by Insurance Website Builder

Our Customer Feedback

Read More

Our latest blogs

  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
  • Carrier
Keener Insurance Solutions LLC
W175N11163 Stonewood Dr
Suite 108
Germantown, WI 53022
P: (262) 293-9144
M: (414) 737-8292
E: michael@keenersolutions.com
Quick Help Links
Home/ About Us/ Refer A Friend/ Get A Quote/ Join Our Newsletter/ Contact Us
Facebook Feed
Social Icon Social Icon Social Icon Social Icon Social Icon
© Copyright. All rights reserved. Powered by Insurance Website Builder