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Why Trust Pierce Insurance Agency
For your convenience, you can expedite your insurance claim by submitting an online pre-claim form. To get started, select the appropriate form from the selection box below and provide as much information as possible regarding your loss. Once you submit your pre-claim information, a Pierce Insurance Representative will contact you as soon as possible regarding your claim.
Personal Auto Claim
Please complete all fields, use N/A or None if it doesn't apply.
Name of Insured:
Policy Number:
Daytime Phone Number:
Evening Phone Number:
Email Address:
Date of Accident:
Location of Accident:
address, city, state and zip
Vehicle Involved:
year, make and model
Vehicle Damage:
brief description
Injuries (if any):
Name, address, phone number, extent of injury, where taken for medical services.
Authority Contacted:
Name, case number, phone number
Violations Issued:
list all violations issued
Breif Description of Events:
  
Commercial Auto Claim
Please complete all fields, use N/A or None if it doesn't apply.
Business Name :
Policy Number:
Contact Person:
Daytime Phone Number:
Evening Phone Number:
Contact Email Address:
Date of Accident:
Location of Accident:
address, city, state and zip
Vehicle Involved:
year, make and model
Vehicle Damage:
brief description
Injuries (if any):
Name, address, phone number, extent of injury, where taken for medical services.
Authority Contacted:
Name, case number, phone number
Violations Issued:
list all violations issued
Breif Description of Events:
  
Homeowners Claim
Please complete all fields, use N/A or None if it doesn't apply.
Name of Insured:
Policy Number:
Daytime Phone Number:
Evening Phone Number:
Contact Email Address:
Date of Damage/Accident:
Property Address:
address, city, state and zip
Propert Damage:
brief description of damage and cause
Injuries (if any):
name, address, phone number, extent of injury, where taken for medical services.
Authority Contacted:
name, case number, phone number
Breif Description of Events:
brief description of events that lead to the accident/damage
  
General Liability Claim
Please complete all fields, use N/A or None if it doesn't apply.
Name of Insured:
Policy Number:
Daytime Phone Number:
Evening Phone Number:
Contact Email Address:
Date of Incident:
Location of Incident:
address, city, state and zip
Damages:
brief description of damage and cause
Injuries (if any):
name, address, phone number, extent of injury, where taken for medical services.
Authority Contacted:
name, case number, phone number
Breif Description of Events:
brief description of events that lead to the incident/damage
  

Workers Compensation Claim

Please click here to download a "First Report of Injury" form.
Please print the form, complete and fax to:
Pierce Insurance Agency at 320.693.3452.



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- Pierce Insurance Agency -
serving customers since 1974
33 East Highway 12 - Litchfield, MN 55355
Phone - 320.693.6115 | Fax - 320.693.3452 | Toll Free - 1.800.693.6115
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