DeLauder Insurance Agency, LLC

Youthful Driver Video - NOW ONLINE!!

Click HERE to be directed to Erie's site. Once there, click on the link to the IIHS video under the Car Safety & Other Discount section.

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Visit our online customer service center here.

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Auto Loss Notice

Automobile Loss Notice

Contact Information

Your Full Name:
(as listed on policy now)

Your Email Address:

Daytime Phone

Description of Loss:

Time & Date of Accident/Claim:

Time AM PM
Date

Location of Accident:

Description of Accident:

Police Notified?:

Yes No

Were you ticketed?:

Yes No

If you received a ticket, what was it for?:

Driver Name:

Any Additional Information Not Requested Above:

Please Note: Submitting this form via the website does not constitute a "formal" claim. Please contact us or your insurance company to notify of a loss.

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"Insuring Your Future Since 1984"