Property Loss Notice

Please use the form below to notify us of any loss or damage to your property insured through this company/agency. Please note that this form is for notification purposes only and does not constitute making an actual claim. One of our representatives will contact you shortly after receiving this notification.

» Required Fields

I understand that this does not constitute an actual claim, but is rather a notification to my agent of an existing loss or claim, and may help expedite the claim process once I have filed.

Policy Holder Information

Please be sure to supply your phone number and email address so that we may contact you after receiving this notification.


Time and Description of Loss

A.M. P.M.

Authority Notification

Were the Police or Fire Deparment. Called? Yes No

Property Status

Is the Property Habitable? Yes No

Report Information

Additional Comments

Please give any additional comments you feel appropriate for this Loss Notice.

Affinity Marketing Plus, Inc.
401 Linton Blvd.     suite 202A 
Delray Beach
, FL 33444   
Phone: 561-395-1102
Toll Free: 855-367-8779
Fax: 561-392-3968