Vehicle Accident Report
For non-emergency claims please use the form below. For immediate assistance please call our office at (269) 381-9442 or (800) 315-8740 or email at info@millerschuring.com

For 24 hours assistance or to contact your insurance company directly Click Here

* indicates required fields 
  *Insured Name on Policy:
  Email Address:
  *Date/Time of Accident:
  *Vehicle Involved:
  *Driver's Name:
  *Location of Accident:
  *Police Dept. Called:
  *What Happened?:
  *Damage to Your Vehicle/Is it Drivable?:
  *Other Driver Name:
  *Other Driver Phone Number:
  *Other Driver Insurance Information:
  This Report Filled Out By:
  *Contact Phone Number:

Please click the SUBMIT button to continue.
 

PO Box 2133 Kalamazoo, MI 49003
5136 Lovers Lane Suite 104, Portage, MI 49002
Phone: 269-381-9442               Toll-Free 1-800-315-8740                         Fax: 269-381-8944

Privacy Policy              Terms & Conditions                          Disclaimer 

  Site Map