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If you experienced damage to a building or other property you own, please complete the form below and an InterWest property and casualty claims professional will contact you as soon as possible, but not more than one business day. We ask you to complete the form to the best of your ability, however, if you don't have all of the information or it doesn't apply, simply leave it blank. If this is a claim involving major injuries or death, see the Emergency Claims Reporting instructions on the Submit A Claim page. Let our experience guide you!

InterWest Policy Holder Account Name *

InterWest Client Policy Number

InterWest Policy Holder Account Address

Street Address

City

State

Zip Code

Claim Contact First Name *

Claim Contact Last Name *

Email *

Phone *

INCIDENT INFORMATION

Describe The Incident

Description of Damaged/Stolen Property

Estimated Amount Of The Loss

Date of the Incident *

Time

Loss Location

Street Address

City

State

Zip Code

Police Report

Yes

Is there video of the incident?

Yes

Was The Property Stolen Out Of A Vehicle?

Yes

Please attach a copy of photos or any other information obtained at the scene of the accident. Also, attached a copy of any other information obtained regarding the incident.

Max. file size: 40 MB.

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INCIDENT INFORMATION

Please preserve a copy of the video.

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