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Business Loss Notice 
Business Loss Notice

Contact Information
Your Full Name:
(as listed on policy now)
Your Email Address:
Daytime Telephone Number:
Description of Loss
Time & Date of Accident/Claim:
 Time AM PM
Date
Location:

Type of Accident/Claim:

Property
Liability
Automobile
Workers Comp
Other:

Description of Loss:
Name(s) of Injured Parties:
Vehicle Description:
(applicable to Auto Claims Only)
Driver Name:
(applicable to Auto Claims Only)
Any Additional Information Not Requested Above
Please Note: Insurance coverage cannot be bound without a written binder from our office.

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Exceptional savings for "average" people.

“I use Winooski Insurance personally and also refer them to my clients. Their rates are very competitive and their staff is friendly and effi cient.”

Mark Chaffee
Mortgage Financial, Inc.

“When I switched my home and auto coverage to Winooski Insurance, they didn’t just try to sell me the same policy. They asked me the right questions to get me better coverage, while saving me money. I feel confi dent that they shop the best price for me each year.”

Sue Gosselin
Colchester, VT.


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