Form Claims Step1

Reporting a claim is fast and easy.

Our number one priority is to make the claims process simple. Your first step is submitting the claim online. Please use the below form to process your claim and a Bluefire representative will contact within 24 hours to review your claim.

1

Claim Report Detail
2

Vehicles
3

Other Involved Parties
4

Summary
5

Documents

Claims Report Details

Fields marked with a red asterisk (*) are required.

Policy Number *

Date of the incident *

Time of Accident

Select the type of loss that best fits your incident *

Details of Loss *

Location Of Accident

Country

Street #

Street

Zip Code *

State

City

Reported By

Reported by *

First Name *

Last Name *

Home Phone

Office Phone

Cell Phone *

Country

Street #

Street

Apt/suite #

Zip Code *

State

City

County

Insured Party

First Name

Last Name

Home Phone

Office Phone

Cell Phone

Country

Street #

Street

Apt/suite #

Zip Code

State

City

County