Damage Report

Complete the form below to request to have any damage occurred to your property that was caused by a natural disaster. Someone from our office will be in contact with you as soon as possible or you can reach us directly at (606) 432-0210 or (606) 437-4126.

If you are in immediate danger call 911!

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Phone *

Email

Email of Incident

Address of Damage *

Address Line 1

Address Line 2

City

— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Date of Incident *

Type of Damage *

Upload a Picture of the Damage (optional)

Click or drag files to this area to upload. You can upload up to 20 files.

Submit