Online Claims Submission Form - PAUL R. WHITE & COMPANY, INC.

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Main Number: 713-780-3200

Online Claims Submission Form

If you do not receive a confirmation email after clicking on the green Submit button, please try submitting the form again or email claims@prwhite.com. Additionally please check your spam folder for your email notification of the submitted claim.

Online Claims Submission Form

Submitted by Company Information

Submitted by

Company Name

Phone Number

Email Address

Policy Information

Insurance Company

Policy Number

Policy Effective Date

Policy Forms

Policy Coverage

Loss Information

Date of Loss

Claim Number

Where did the loss/accident/damage occur?

Street 1

Street 2

City

State/Province

Zip/Postal

Type of Loss

Insured Information

Insured Company or Individual Name

Insured Company Name

Insured Individual Name

Insured Company Name

Insured Individual Name

Point of Contact

First Name

Last Name

Insured Address

Check here if Insured Address is the same as the Loss Address

Check here if Insured Address is the same as the Loss Address

Street 1

Street 2

City

State/Province

Zip/Postal

Insured Home Phone

Insured Work Phone

Insured Mobile Phone

Best Number to Call

Home Phone

Work Phone

Mobile Phone

Claimant Information

Claimant Company or Individual Name

Claimant Company Name

Claimant Individual Name

Claimant Company Name

Claimant Individual Name

Point of Contact

First Name

Last Name

Claimant Address

Check here if Claimant Address is the same as the Loss Address

Check here if Claimant Address is the same as the Loss Address

Street 1

Street 2

City

State/Province

Zip/Postal

Claimant Home Phone

Claimant Work Phone

Claimant Mobile Phone

Best Number to Call

Home Phone

Work Phone

Mobile Phone

Additional Instructions

Actions or Special Instructions

Notes/Comments

Policy or Supporting Documentation - Can upload up to 4 files. Limit 5MB per file.

Drop a file here or click to upload

If you do not receive a confirmation email after clicking on the green Submit button, please try submitting the form again or email claims@prwhite.com. Additionally please check your spam folder for your email notification of the submitted claim.

About Us

Paul R. White & Company, Inc., has provided the quality service and expertise required by the ever-changing claims industry throughout Texas & the United States.

© 2024 Paul R. White & Company, Inc. All Rights Reserved. Website by Solace Media.

Home
About
Team
Contact Us
Submit A Claim
Main Number: 713-780-3200

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