Submit a Claim

Fill out the form below.


MEMBER NAME:
Joseph Member
MEMBER ID:
12345678919

Select Type of Claim

The member should call PURE directly if the claim reporting is an emergency.

Auto

Auto

INSURED (MEMBER) NAME:

Joseph Member

INSURED PHONE NUMBER:

(212) 222-9876

INSURED EMAIL ADDRESS:

jmember@gmail.com

LOSS REPORTED:

09/20/13

MEMBER ID:

12345678919

* PRIMARY CONTACT FOR CLAIM:
* DATE OF INCIDENT / ACCIDENT:
* INCIDENT DESCRIPTION:
* WAS ANYONE INJURED:
ARE THERE OTHER VEHICLES INVOLVED:
INCIDENT / ACCIDENT LOCATION:

Fields marked (*) are required fields


UPLOAD FILES AND / OR PHOTOS:

Auto Glass

The button below will redirect you to a page within safelite.com where you can report your auto glass claim. Safelite is a trusted vendor of PURE and handles auto glass claims for all PURE members.

NEXT

Homeowners

Homeowners

INSURED (MEMBER) NAME:

Joseph Member

INSURED PHONE NUMBER:

(212) 222-9876

INSURED EMAIL ADDRESS:

jmember@gmail.com

LOSS REPORTED:

09/20/13

MEMBER ID:

12345678919

* PRIMARY CONTACT FOR CLAIM:
* IS THERE DAMAGE TO THE HOME:

DATE OF INCIDENT / LOSS:
* INCIDENT DESCRIPTION:
INCIDENT / LOSS LOCATION:

Fields marked (*) are required fields


UPLOAD FILES AND / OR PHOTOS:

Collections

Collections

INSURED (MEMBER) NAME:

Joseph Member

INSURED PHONE NUMBER:

(212) 222-9876

INSURED EMAIL ADDRESS:

jmember@gmail.com

LOSS REPORTED:

09/20/13

MEMBER ID:

12345678919

* PRIMARY CONTACT FOR CLAIM:

DATE OF INCIDENT / LOSS:
* INCIDENT DESCRIPTION:
INCIDENT / LOSS LOCATION:

Fields marked (*) are required fields


UPLOAD FILES AND / OR PHOTOS:

Watercraft

Watercraft

INSURED (MEMBER) NAME:

Joseph Member

INSURED PHONE NUMBER:

(212) 222-9876

INSURED EMAIL ADDRESS:

jmember@gmail.com

LOSS REPORTED:

09/20/13

MEMBER ID:

12345678919

* PRIMARY CONTACT FOR CLAIM:
* WAS ANYONE INJURED:
DATE OF INCIDENT / ACCIDENT:
* INCIDENT DESCRIPTION:


INCIDENT / ACCIDENT LOCATION:

Fields marked (*) are required fields


* UPLOAD FILES AND / OR PHOTOS:

Flood

Flood

INSURED (MEMBER) NAME:

Joseph Member

INSURED PHONE NUMBER:

(212) 222-9876

INSURED EMAIL ADDRESS:

jmember@gmail.com

LOSS REPORTED:

09/20/13

MEMBER ID:

12345678919

* PRIMARY CONTACT FOR CLAIM:
* DATE OF INCIDENT / ACCIDENT:
INCIDENT / ACCIDENT LOCATION:
INCIDENT DESCRIPTION:

Fields marked (*) are required fields


UPLOAD FILES AND / OR PHOTOS: