Walton Agency

As a service for our customers we are happy to offer you the convenience of submitting your claim information via the internet. Please fill out the following form AS COMPLETELY AS POSSIBLE. The more detailed your answers, the faster we can process your information and settle your claim. If you have any problems with this form email us at info@waltonagency.com PLEASE NOTE: Until you receive notice from Walton Agency, verification of coverage is pending.
1. Please provide the following contact information:
Name
Organization
Street address
Address (cont.)
City
State
Zip/Postal code
Work Phone
Home Phone
FAX
E-mail
Web Site Address:
Enter the date of loss :	-- mm/dd/yy
Brief Description of Loss:
What is the type of Loss:	Home Auto Boat Other
Were any people injured?	Yes No Not Applicable
If auto claim, is the car driveable?	Yes No Not Applicable
Was incident reported to the police?	Yes No Not Applicable
Policy number:
Driver Name:
Vehicle type:
Year of vehicle:
Vehicle Make:
Vehicle Model:
Location of Loss (ie. state, street):
Additional Information:

IF YOU DO NOT HEAR FROM WALTON AGENCY WITHIN 48 HOURS
PLEASE CALL.