Skip to content
George Butler Adjusters
Claims handling excellence in Massachusetts, Connecticut and Rhode Island
Home
Who We Are
What We Do
Claims Handling
Guidelines
Service Areas
Submit a Claim
Forms
Contact Us
Home
Who We Are
What We Do
Claims Handling
Guidelines
Service Areas
Submit a Claim
Forms
Contact Us
Submit a Claim
We thank you for the assignment. If this loss is submitted during normal business hours you should receive electronic notification within 24 hours.
Claims Submission Form
Insurance Company
*
Contact at Insurance Company
Email
*
Phone
*
Fax
Claim Number
Policy Number
*
Policy Type
Type of Loss
Date of Loss
*
Date Format: MM slash DD slash YYYY
Loss Location
Insured's Name
*
Insured's Phone Number
*
Insured's Mailing Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Claimant's Name
First
Last
Claimant's Mailing Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Description of Loss:
Upload Files
Drop files here or
Accepted file types: jpg, png, pdf, doc.
You may use this section to upload any files or documents. Allowed file types: jpg, png, pdf Maximum file size 128MB
Go to Top