Homeowners

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Homeowners claim

Policy Number *

Name *

First

Last

Primary Phone *

Secondary Phone *

Best Time to Call *

Morning Afternoon Evening

Preferred Method of Transportation *

Phone Email

Email *

Incident Overview

Date of loss *

Loss Type *

If other, describe below: *

How severe was the damage? *

Describe the Loss/Other Comments *

Submit

Contact Information

Lonnie Short
Short Agency, Inc
107 Ditto Street
Archbold Ohio 43502

419-445-6846 Office
419-445-5103 Fax
419-583-9567 Cell
lonnie.s@shortagency.com

Terry Short
Short Agency, Inc
1398 N. Shoop Ave.
Wauseon Ohio 43567

419-335-9507 Office
419-335-2327 Fax
419-583-9571 Cell
terry.s@shortagency.com

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