Form Claims Step1

Reporting a claim is fast and easy.

Our number one priority is to make the claims process simple. Your first step is submitting the claim online. Please use the below form to process your claim and a Bluefire representative will contact within 48 hours to review your claim.

1

Claim Report Detail
2

Vehicles
3

Other Involved Parties
4

Summary
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Documents

Claims Report Details

Fields marked with a red asterisk (*) are required.

Date of the incident *

Time of Accident *

Select the type of loss that best fits your incident *

Details of Loss *

Location Of Accident

Country *

Street # *

Street *

Zip Code *

State *

City *

Reported By

Reported by

First Name *

Last Name *

Home Phone *

Office Phone

Cell Phone *

Email *

Okay To Call

Yes

Okay To Text

Yes

Okay To Email

Yes

Country

Street #

Street

Apt/suite #

Zip Code

State

City

County

Insured Party