Report A Claim

Report a Claim
Disclaimer: Insurance transactions are NOT effective without acknowledgement
from a Benton Insurance Agency Representative.

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	*Company Name:

	*Contact Person:

	*Phone Number:

	Mobile Phone:

	*Email

	Best Time to Reach You:

	*Date of Loss:

	*Description of Loss:

Benton Insurance Agency
P.0. Box 802350 Valencia, CA 91380	Tel: 800-864-2001 Fax: 800-864-2010