Auto Claims Reporting

Policy Information

Company Name *

Date of Accident/Occurance *

Street Address *

Street Address Line 2

City *

Postal / ZIP Code *

State / Providence *

VIN # of our vehicle *

Driver Information of our Vehicle (if applicable)

Driver Name

Driver Phone

Accident Details

Description of Accident

Was a police report filed? *

Yes

Police Report #

Was a citation ussued? *

Yes

Citation issued to whom?

Any Injuries *

Yes

Describe Injuries

Other party details (if applicable)

Other Party Name

Other Party Street Address

Other Party Street Address Line 2

Other Party City

Point of Contact

Point of Contact Name *

Point of Contact phone # *

Point of Contact email *

Upload photos (images only, 50MB max upload)

Click or drag a file to this area to upload.

Choose File

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If you have any issues please contact claims@echelonig.com
A licensed insurance representative will be reaching out to you within 48 business hours regarding this claim.

Auto Claims Reporting

Policy Information

Driver Information of our Vehicle (if applicable)

Accident Details

Other party details (if applicable)

Point of Contact

Life & Health
Employee Benefits

Commercial
Property + Casualty

Personal
Lines

Our
Story

Need a Member Advocate?

Auto
Claims

Auto Claims Reporting

Policy Information

Driver Information of our Vehicle (if applicable)

Accident Details

Other party details (if applicable)

Point of Contact

Life & Health Employee Benefits

Commercial Property + Casualty

Personal Lines

Our Story

Need a Member Advocate?

Auto Claims

Life & Health
Employee Benefits

Commercial
Property + Casualty

Personal
Lines

Our
Story

Auto
Claims