Non-Emergency Claim Form

Winchester Insurance Inc.
407-365-5656 or Fax: 407-365-0031

This form is designed to e-mail Non-Emergency Claims only. If your claim is an emergency call
407-365-5656 (fax: 407-366-0031). We will be in touch with you in 24-48 hours or in one business day.

Please provide the following information:

Name

Street Address

City ST: Zip:

Work Phone Home Phone:

E-mail

Type of Policy: Policy #

Company:

Date of Loss: Time of Loss:

Description of Claim or Accident:

Police Report #
Name of Police Department:

Other comments:

Use the space below for any questions or additional comments. We will be in touch with you within 24-48 hours or one business day. (After you receive confirmation of your entry please use your browser "Back" button to return to our site.)

Thank you, and remember to use your "Back" button to return to our site.

*Name*
*Street Address*
*City*	ST: Zip:
*Work Phone*	Home Phone:
*E-mail*

This form is designed to e-mail Non-Emergency Claims only. If your claim is an emergency call 407-365-5656 (fax: 407-366-0031). We will be in touch with you in 24-48 hours or in one business day.

Copyright © 2000 Winchester Insurance, Inc. All rights reserved. Revised: December 15, 2006

This form is designed to e-mail Non-Emergency Claims only. If your claim is an emergency call
407-365-5656 (fax: 407-366-0031). We will be in touch with you in 24-48 hours or in one business day.

Copyright © 2000 Winchester Insurance, Inc. All rights reserved.
Revised: December 15, 2006