Dutchess County’s First Independent Adjusters Serving 10 NY Counties Since 1944

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Our Territory

Clients

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Insurance Company Information

Insurance Company 

Contact Name 

Mailing Address 

Phone 

Fax 

Email 

Insured Information

Insured Name 

Mailing Address 

City 

State 

Zip 

Phone 

Claimant Information

Claimant Name 

Mailing Address 

City 

State 

Zip 

Phone 

Policy # 

Claim Information

Claim # 

Date of Loss 

Type of Loss 

Loss Location 

Coverage Limits (A,B,C,D, Liability)


Policy Forms and Endorsements

* Special Instructions (PLEASE BE SPECIFIC)

 

       

* Indicates required filed.

6805 Route 9 Suite 28  • P.O. Box 491  • Rhinebeck, NY  12572
Phone: (845) 876-0700  •  Fax: (845) 876-0706

Night Phone Numbers:
 914-772-0024 or 845-876-5481 or 914-475-0612 or 845-255-4741

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