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"It is without hesitation that we provide a testimonial for Hartland Insurance Agency and James McGrain. They quoted our automobile & homeowners insurances, and of course we were skeptical that they could do any better than our current provider. Boy were we wrong. They provided us with a very detailed quote and options to fit our specific needs, which we've never had before. James is a terrific agent who always kept us apprised of what actions needed to be taken care of. He was very mindful of customer satisfaction and even came to our office to process the paperwork. They are also an organization that gives back to their community, a trait we find highly commendable. We are happy to provide this testimonial for Hartland Insurance Agency."

~ Jana & Scott Warford

Auto Loss

Insured
Name: Residence Phone: Business Phone:
Email:
Address: Apt:
City: State: Zip:
Contact Person: Where to Contact: When to Contact:
Residence Phone: Business Phone:
Loss
Location of Accident:
City: State: Zip:
Authority Contacted: Report #: Violations/Citations:
Description of Accident:
Insured Vehicle
Year: Make: Model:
VIN #: Plate #:
Owner's Name: Phone:
Owner's Address: Apt:
City: State: Zip:
Driver's Name: Business Phone: Residence Phone:
Driver's Address: Apt/Ste:
City: State: Zip:
Relation to Insured: Date of Birth: Driver's License #:
Purpose of Use: Used with Permission?
Yes No
Describe Damage: Estimate Amount:
Where can Vehicle be Seen? When?
Property Damaged
Describe Property: (if auto: year, make, model, plate no.)
Other Veh./Prop. Ins.? Company/Agency Name: Policy #:
Yes No
Owner's Name: Business Phone: Residence Phone:
Owner's Address: Apt:
City: State: Zip:
Other Driver's Name: Business Phone: Residence Phone:
Other Driver's Address: Apt:
City: State: Zip:
Describe Damage: Estimate Amount: Where can Damage be Seen?
Injured
Name: Phone: Age:
Address: Apt:
City: State: Zip:
Name: Phone: Age:
Address: Apt:
City: State: Zip:
Witnesses or Passengers
Name: Phone: Age:
Address: Apt:
City: State: Zip:
Name: Phone: Age:
Address: Apt:
City: State: Zip:

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