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Claim Form:

Named Insured:Policy Number:
Phone Number:Fax Number:
Email Address:

          Date of Loss:       Time of Loss: 
Location of Loss: Street  City
State   Zip  

Description of Incident/Loss:                   
Were the Authorities Called?
Any Additional Information that might help expiditing the claim:

By Clicking Submit
I understand this is not an actual claim, but notifying my agent 
will help with the processing of my claim.



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Target Financial & Insurance Services
6630 Flanders Drive
San Diego, CA 92121

Tel: (800) 450-8013
Fax: (800) 434-8053
Info@targetinsuranceservices.com

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