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Serving the low country since 1981
Homeowners Auto Flood Boat Business
Home > Property Loss Notice
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Property Loss Notice


ALL fields must be filled in in order for the form to SUBMIT. If you cannot complete a field, please enter N/A.

INSURED INFORMATION
First Name *
Last Name *
Street *
City *
State / Province *
ZIP / Postal Code *
Residence Phone *
Business Phone *
Cell Phone
E-Mail Address *
LOSS INFORMATION
Date of Loss *
Date Reported *
Reported By *
Reported To *
Previously Reported *
Location of Loss *
If other location, please show address
Loss Reported to Authority? *

If yes, name of authority
Report # if available
Other Insurance *

If yes, name of company
Policy #
Type of Loss




















If other, please explain
Estimated Loss Amount *
Description of Loss *
Remarks/Other Insurance *
OTHER CONTACT (Not Insured) INFORMATION
Contact's Name *
Mailing Address *
City *
State / Province *
ZIP / Postal Code *
Residence Phone *
Business Phone *
Where to Contact *
When to Contact *
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3:00 PM4:00 PM5:00 PM
6:00 PM7:00 PM8:00 PM
9:00 PM10:00 PM11:00 PM
POLICY INFORMATION
Homeowner
Company Name *
Policy Number *
Effective Date *
Expiration Date *
AOP Deductible *
Wind Deductible *
Water Damage Deductible *
Please complete the following if the company providing flood or wind is other than above.
Flood
Company Name *
Policy Number *
Effective Date *
Expiration Date *
Wind
Company Name *
Policy Number *
Effective Date *
Expiration Date *
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.
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Physical Address

88A Main Street
Hilton Head island, SC 29926

Phone: (843) 681-4340
Fax: (843) 681-8373
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