Report an Auto Claim

Use the form below to report an automobile claim to The Main Street America Group. If your claim involves injuries, please call our Customer Care Unit 24 hours a day at (877) 425-2467.

Fields marked with a red asterisk (*) are required.

Insured information
Policy Number
Name*
Address 1*
Address 2
City*		State*	Select here ALABAMA ALASKA ALBERTA ALL OTHER ARIZONA ARKANSAS BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MANITOBA MARYLAND MASSACHUSETTS MEXICO MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW BRUNSWICK NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NEWFOUNDLAND NORTH CAROLINA NORTH DAKOTA NORTHWEST TERR NOVIA SCOTIA OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDW ISLAND PUERTO RICO QUEBEC RHODE ISLAND SASKATCHEWAN SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING YUKON TERRITORY
Zip Code*
Contact information
Name*
Contact phone number (e.g., 3215551212)*			Contact phone extension
Work phone number			Work phone extension
E-mail address*
Accident details
When did the accident occur?*
What time did the accident occur?	You may enter a 12- or 24-hour time with or without AM or PM (e.g., 12:30 or 2:15 PM).
Where did the accident occur?
Address*
City*		State*	Select here ALABAMA ALASKA ALBERTA ALL OTHER ARIZONA ARKANSAS BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MANITOBA MARYLAND MASSACHUSETTS MEXICO MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW BRUNSWICK NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NEWFOUNDLAND NORTH CAROLINA NORTH DAKOTA NORTHWEST TERR NOVIA SCOTIA OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDW ISLAND PUERTO RICO QUEBEC RHODE ISLAND SASKATCHEWAN SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING YUKON TERRITORY
Were the police and/or fire department at the scene?	Yes No
Description of accident:
Insured vehicle information
Vehicle year, make and model*
Vehicle plate number
Describe damage to vehicle*
Is the vehicle driveable?	Yes No
If vehicle is not driveable, where can it be seen?
Address
City		State	Select here ALABAMA ALASKA ALBERTA ALL OTHER ARIZONA ARKANSAS BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MANITOBA MARYLAND MASSACHUSETTS MEXICO MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW BRUNSWICK NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NEWFOUNDLAND NORTH CAROLINA NORTH DAKOTA NORTHWEST TERR NOVIA SCOTIA OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDW ISLAND PUERTO RICO QUEBEC RHODE ISLAND SASKATCHEWAN SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING YUKON TERRITORY
Zip Code
Insured driver information
Check here if the insured driver is the same person as the insured above.
Name*
Address 1*
Address 2
City*		State*	Select here ALABAMA ALASKA ALBERTA ALL OTHER ARIZONA ARKANSAS BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MANITOBA MARYLAND MASSACHUSETTS MEXICO MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW BRUNSWICK NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NEWFOUNDLAND NORTH CAROLINA NORTH DAKOTA NORTHWEST TERR NOVIA SCOTIA OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDW ISLAND PUERTO RICO QUEBEC RHODE ISLAND SASKATCHEWAN SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING YUKON TERRITORY
Zip Code*
Primary phone number		Primary phone extension
Secondary phone number		Secondary phone extension
Date of Birth
License Number
Other vehicle/property damage involved
Other vehicle/property owner name
Address 1
Address 2
City		State	Select here ALABAMA ALASKA ALBERTA ALL OTHER ARIZONA ARKANSAS BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MANITOBA MARYLAND MASSACHUSETTS MEXICO MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW BRUNSWICK NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NEWFOUNDLAND NORTH CAROLINA NORTH DAKOTA NORTHWEST TERR NOVIA SCOTIA OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDW ISLAND PUERTO RICO QUEBEC RHODE ISLAND SASKATCHEWAN SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING YUKON TERRITORY
Zip Code
Primary phone number		Primary phone extension
Secondary phone number		Secondary phone extension
Other vehicle information
Vehicle year, make and model
Vehicle plate number
Describe damage to vehicle:
Other driver information
Name
Address 1
Address 2
City		State	Select here ALABAMA ALASKA ALBERTA ALL OTHER ARIZONA ARKANSAS BRITISH COLUMBIA CALIFORNIA COLORADO CONNECTICUT DELAWARE DIST. OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MANITOBA MARYLAND MASSACHUSETTS MEXICO MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW BRUNSWICK NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NEWFOUNDLAND NORTH CAROLINA NORTH DAKOTA NORTHWEST TERR NOVIA SCOTIA OHIO OKLAHOMA ONTARIO OREGON PENNSYLVANIA PRINCE EDW ISLAND PUERTO RICO QUEBEC RHODE ISLAND SASKATCHEWAN SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING YUKON TERRITORY
Zip Code
Primary phone number		Primary phone extension
Secondary phone number		Secondary phone extension
Date of birth
License number