COVID-19 Related Business Interruption Claim

Claim Subject (required)

Your Name (required)

Your Email (required)

Your Phone Number (required)

What is the Name of Your Business? (required)

What Type of Business Do You Own? (required)

What State is Your Business Located In? (required)

What City is Your Business Located In? (required)

What Date was Your Business First Impacted? (required)

How much revenue has your business lost to date? (required)
—Please choose an option—$0 to $49K$50K to $99K$100K to $200KOver $200K

Who is Your Business Insurance Carrier? (required)

Are your business insurance policy premiums up to date? (required)
—Please choose an option—YESNO

If you answered "No" to the previous question, when did you last pay your premium?

If you have a full copy of your business insurance policy and would like us to review it, please attach it here