Auto Insurance Quote New York by Walenta & Clark Agency, Inc.

Bill Clark, Bob Walenta & staff

Auto ID Cards

Change of Address

Change of Name

Certificate of Insurance

Visit our online customer service center here.

Proudly Supporting Music & the Arts

as musicians themselves, Bob Walenta & Bill Clark understand the need to promote the arts.

Property Loss Notice

Contact Information

Your Full Name: (as listed on policy now)
Your Email Address:
Daytime Telephone Number:

Description of Loss

Time & Date of Loss:	Time AM PM Date
Location:
Description of Loss:
Police or Fire Department: Notified?	Yes No
If Yes, Please Specify:
Is Property Habitable?:	Yes No
If No, Where Are You Staying: or Planning to Stay?	(Please include Address & Telephone #'s you can be reached at):

Mortgagee or Bank Information

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.

Enter the security code you see above. Code is NOT case sensitive.*