Report a claim

Let us know what happened.

Submit a preliminary claim report.

If you are an affected third party, please complete the form below or call Falcon at 800-929-3252. If you are a Falcon customer, please log in.

Falcon Policy Number

Date of Incident

Time of Incident

Location of incident

Street

City

State

Falcon insured driver information

First Name

Last Name

Drivers License Number

Street

City

State

Phone Number

Email Address

Year

Make

Model

VIN

License Plate

Other driver information

First Name

Last Name

Drivers License Number

Street

City

State

Insurance Company

Policy Number

Phone Number

Email Address

Year

Make

Model

VIN

License Plate

Description of Incident

Police on the scene?

Yes No

Police Department

Report number

Injuries

Does anyone claim to be injured?

Yes No

If yes, provide their names and contact information:

Name Phone Email

Additional Information

Name of person completing form

Relationship to Insured/Policyholder

Phone Number

Email Address

Photo Upload

If available, please upload pictures of damaged vehicles and/or property.

Upload Photo

Maximum size 2MB

Be advised that FALCON INSURANCE COMPANY reserves the right to thoroughly investigate all claims that are reported. Submitting this form does not imply or confirm coverage for a loss. Per the terms and conditions of the FALCON Policy, you are required to cooperate in the investigation of any claim. Failure to cooperate may result in a denial of coverage.

WARNING: Any person who knowingly, and with intent to injure, defraud or deceive an insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.

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