Report A Claim

PLEASE NOTE:
Any changes requested on this website are NOT official until you receive written confirmation from The Hoxton Agency, Inc.

* All fields are required.

PERSONAL DETAILS

Caller*

Caller's Phone*

Policy Owner*

Policy Owner's Phone*

Pilot*

Pilot's Phone*

Aircraft N#*

INCIDENT DETAILS

Date of Loss*

Time of Loss*

Description of Loss*

Damage to Aircraft?*

Yes No

Property Damage?*

Yes No

Bodily Injury?*

Yes No

CALL BACK DETAILS

Call Back Contact Name*

Call Back Phone*

Call Back Email*

Click here to download this form in PDF format.

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After you have completed the form in its entirety, please print and sign the document before faxing it to our office. If you choose to submit the form via e-mail, you must have the capability of producing an authentic electronic signature, as all forms require an original signature. Fax the forms to: (304)876-3530.