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Homeowners 

PROPERTY LOSS NOTICE

POLICY HOLDER INFORMATION

Please be sure to supply all if your contact information so we
may promptly contact you after receiving this notification.

Name Insured:
Address:
Phone #: Work     Home
Email:
TIME AND DESCRIPTION OF LOSS
Time & Date of Loss
Time a.m.
p.m.		     Date
Location of Property:
Description of Loss:
AUTHORITY NOTIFICATION

Were the Police or
Fire Dept. Called?

 Yes     No
If Yes, which Authority?
PROPERTY STATUS
Is the Property habitable? Yes     No
If No, where are you staying,
so we may contact you		 (Address and Telephone)
REPORT INFORMATION
Reported by:
Title (if any):
Date:
ADDITIONAL COMMENTS
Please provide and additional comments you feel appropriate for this Loss Notice.

DISCLAIMER:

I understand that by completing this form it does not constitute an actual
claim, but is rather a notification to my agent of an existing loss or claim,
and may help expedite the claim process once I have filed.

 One of our representatives will respond to your submission as soon as possible.

Copyright © 2003 by InsuranceNewsNet
Property Policy Change Request
 
POLICY HOLDER INFORMATION
Name Insured:
Phone #:     E-Mail:
Effective Date
of Change:
PLEASE CHECK NATURE OF CHANGE:

Add/Delete from schedule
Add endorsement
Mortgagee Change
Change of mailing address/phone number
Increase/Decrease Limit of Insurance
Other

PLEASE DESCRIBE SPECIFICS OF YOUR REQUEST:

I understand that my coverage (or changes in coverage) ARE NOT binding via this
online request; Changes ARE ONLY considered binding when I receive an email
(or fax) response from my agent indicating that they have received my request.


One of our representatives will respond as soon as possible.

Copyright © 2003 by InsuranceNewsNet

YOUR "ONE SOURCE SOLUTION" FOR ALL YOUR BUSINESS NEEDS

Kite Insurance Agency LLC
304 W. Cervantes St., Pensacola, FL 32501
Phone: 850-438-0008 - FAX: 888-611-6979

Hours of Operation:

Monday - Thursday 9:00 a.m. - 5:00 p.m.

Friday 9:00 a.m - 1:00 p.m.

Closed for Lunch 12 -1