LOCAL INSURANCE ADVICE · PEORIA, ILLINOIS

MON–FRI 9AM–5PM • 309-673-5544

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Report an Auto Claim

Tell the agency about an auto loss.

Send a service request.

Use the existing agency form below to submit your details.

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

Policy Number:

Your Name:

First Last

Contact Person:

Whom should the adjuster contact about repairs?

Name:

Home phone:

Work phone:

Email:*

Authority Contacted:

Police department:

Report number:

Claim Information:

Date of loss:

Location of claim:

Cause of Loss:

Describe, if other cause of loss:

Your Damaged Car:

Year/Make/Model:

Driver's name/address:

Driver's phone number:

Describe your damage:

Is the car driveable?

Yes

If not, where is it located?

Persons Injured:

Name and address:

Phone number:

Nature of Injuries:

Describe Other Car:

Year/Make/Model:

Owner's name / address:

Owner's Phone Number:

Driver's name/address:

Driver's Phone Number:

Describe damage:

Insurance agent/company:

Describe What Occurred:

Comments and/or Other Information

Insurance coverage will not be canceled, bound or modified without a written confirmation from Ledbetter Insurance Agency.

Coverage will not be canceled, bound, or modified without written confirmation from Ledbetter Insurance Agency.

Here when you need us

Speak with a local agent.

For urgent claims or coverage questions, call the agency directly. A form request does not change or bind coverage.

Call 309-673-5544

Visit the office
308 North Western Avenue
Peoria, IL 61604
Mon–Fri · 9AM–5PM

Get directions and details →

Good neighbors, good service

Real people. Right here in Peoria.

Questions about coverage or a policy? Our office is a phone call away.

Call 309-673-5544

Like a Best Friend
from Beginning to End.

308 North Western Avenue
Peoria, IL 61604
Mon–Fri, 9AM–5PM

Text Us · 309-416-4324