Non-Emergency Auto Claim Report

If your accident involves serious injury, or otherwise requires immediate attention, please call our office at (207) 799-5541 or (800) 373-5541, 24 hours a day, 7 days a week.

Your Account Information
Policyholder's name:*
FirstLast
Daytime phone number:*
(###)### - ####
Your email address:
Accident Details
Driver's name:
FirstLast
Year/make of your vehicle:
Date and time of accident:
Location of accident:
Please describe the accident:
Please describe any damage to your vehicle, and any inquiries:
Police report filed?
- Yes
- No
Name of police department:
Information About the Other Vehicle
Owner's Name:
FirstLast
Owner's address:
Street AddressAddress Line 2CityStateZip Code
Owner's phone number:
(###)### - ####
Driver's name:
FirstLast
Driver's phone number
(###) ### - ####
Other driver's insurance company:
Please describe any damage to the other vehicle, and any injuries:

Policy Services

Non-Emergency Auto Claim Report

Your Account Information

Accident Details

Information About the Other Vehicle

Noyes, Hall & Allen Insurance · 170 Ocean Street · South Portland, ME · 04106 · 207-799-5541