Report a Claim On-Line

Complete this form to provide us with contact information. A Lighthouse representative will contact you on the next business day to obtain the necessary information to allow us to begin the claims handling process. If your loss involves an emergency situation, please follow the link to the appropriate insurance company website for information on 24-Hour claim reporting service.
First Name:
Last Name:
Street Address:
City/State/Zip:
Daytime Phone:
Evening Phone:
Best Time To Call:
Email Address:

General Comments: