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FILE AUTO CLAIM
First Name:
Last Name :
Email:
Phone:
Insurance Company :
Policy Number :
Vehicle Year :
Vehicle Make :
Vehicle Model :
Driver of Vehicle :
Date of Loss :
Time of Loss
Cause of Damage :
Theft
Accident
Other
Brief Description of Incident :
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Please acquire a copy of the Police report as soon as possible.
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Phone:
856.767.8330
info@luzinsurance.com
Location:
Berlin Township Office
304 Thurman Ave
West Berlin, New Jersey 08091
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