MOTOMAXX POLICY INFORMATION
Date of Loss *
Policy # *
First Name *
Last Name *
Address
City
Prov/Postal
Phone # *
Email
Prefer Contact Method
By Phone
By Email
Type of Claim *
Total Loss
Partial Loss
Deductible Reimbursement
Vehicle Info *
Year:
Make:
Model:
PRIMARY INSURANCE CLAIM INFORMATION
Insurance Company *
Claim Number *
Adjuster
Repairer Info
OTHER INFORMATION
Brief Description of Incident
Preview Claim Report