Report an Auto Claim - Cooke Insurance

Contact Information
If this is an after hours emergency claim and immediate assistance is required, please call us at 1-800-566-5666 to speak with a claims adjuster.
- Name*
  First Last
- Company name
- Email*
- Phone*
About the Incident
- Date of incident*
  MM slash DD slash YYYY
- Time of incident*
  
  : Hours
  
  Minutes
  
  AM/PM
- Location
- Please describe the incident
Driver & Vehicle Information
- Driver's name
- Driver's date of birth
- Driver's license number
- Vehicle info
- Please describe damage to vehicle in this incident
- Is vehicle drivable?
  - Yes
  - No
- If not, where is vehicle currently?
- If authorities were on scene, please provide police report number
Other Driver Information
If another vehicle was involved, please provide:
- Other driver's name
- Other driver's license number
- Other driver's insurance company
- Other vehicle owner's name
- Other driver's email
- Other driver's phone
Injuries & Witnesses
- If there were any injuries, please describe
- If there were any witnesses, please list names and contact info

Contact Information