REPORT A CLAIM

Please use the form below to report a claim. After submitting this information, you will be contacted by a member of our staff during the next business day. We will schedule a convenient appointment time for you to have one of our experienced adjusters visit your property to inspect the damages. If you require immediate assistance, please call 1-800-HILLIS1. We are available 24 hours a day, 7 days a week.
Complete and submit the form below: * - required

Full Name: 

Address: 

 

City: 

State/Territory: 

Zip: 

Home Phone: 

Work Phone: 

Cell Phone: 

E-Mail: 
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What is your homeowner's insurance company?


Have you contacted them?
   YES    NO

Description of loss and damages:

Approximately when did this occur?

How did you hear about our company?

Would you like our brochure mailed to anyone else you know?
   YES    NO
If yes, please list their name(s) and address(es) below:
 
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