Report a Claim
We understand that experiencing a loss can be stressful. Please complete this form to report your claim. A Gold Key Insurance representative will contact you shortly to assist you through the process. If this is an Emergency call 911. We will report your claim to the insurance company and dispatch an Emergency Restoration if required.
Policy Holder Information :
Name
First Name
Last Name
Policy number
Email
example@example.com
Phone Number
Please enter a valid phone number.
3. Claim Information :
Date of Loss
-
Month
-
Day
Year
Date
Description of Loss(Provide a detailed description of what happened and the extent of the damage)
Submit
Should be Empty: