Online Claim Form

We accept your Claim Reporting Form by regular or express mail, fax or online. Download Form here.


To submit your form by fax, send it to (267) 332-0841, or by email to 


You can also submit your claim online here.


Office Address

One Greenwood Square

3333 Street Road, Suite 305

Bensalem, PA 19020

Phone (267) 332-0814

Toll-Free (800) 608-1010

Fax (267) 332-0841

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