Leavitt Group of Atlanta

Claims
To make a claim please fill out the form below. You may also contact your carrier directly to report a new claim. To find your carrier's phone or fax number click here.

Submit a Claim:
Name of Insured:
Email Address:
Home Telephone:
Work Telephone:
Other Telephone (Cell):
Date of Claim:
Time of Claim:
Insurance Company:
Insurance Type:
Type of Claim:
Brief Description of Claim:
Contact Information of Other People Involved:
List Authorities that were Called:
Any Other Pertinent Comments:

After Submitting this Form we will contact you as soon as possible.