File An auto claim

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FILE AN AUTO CLAIM

AUTO CLAIM FORM

Fill out the form below, or download and email us the Auto Claim Form PDF.

Name

Phone

Date of Incident

Home Address

Time of Incident

Incident Location

Vehicle Year

Vehicle Make

Vehicle Model

Vehicle VIN

Vehicle driver

Description of Incident:

Did you Contact the Police Department?

Report Number

Injuries

Other Driver Name

Other Driver Insurance

Other Driver Address

Other Driver Phone

Other Driver Vehicle

Other Driver Plate

Other Driver Car Color

Witness Name

Witness Phone

Witness 2 Name

Witness 2 Phone

Have You Reported the Claim?

Contact Info

Jamestown

716.664.3890

[email protected]

Mon - Fri 8:30AM - 5:00PM

Saturday & Sunday Closed

205 Fluvanna Ave

Jamestown, NY 14701

Buffalo

716.822.6874

[email protected]

Mon - Fri 8:30AM - 5:00PM

Saturday & Sunday Closed

1926 Clinton St.

Buffalo, NY 14206

Welcome to Cynthia Woltz Insurance Agency, Inc, located in Jamestown, and Buffalo, NY.

Jamestown Office

Buffalo Office

Email

Welcome to Cynthia Woltz Insurance Agency, Inc. We're here to help.

File An auto claim

FILE AN AUTO CLAIM

AUTO CLAIM FORM

Contact Info

Jamestown

716.664.3890

Mon - Fri 8:30AM - 5:00PM

205 Fluvanna Ave

Buffalo

716.822.6874

Mon - Fri 8:30AM - 5:00PM

1926 Clinton St.

Jamestown, NY Contact

Buffalo, NY Contact

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