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Sims Insurance Services
4621 N Maize Rd, PO Box 369
Maize, Kansas 67101
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Phone: 316-722-9977
Fax: 316-729-4744
Toll Free: 866-722-9977
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     CLAIM FORM

Claim Form

First & Last Name:  
Street Address:  
City, State & Zip:  
E-Mail Address:  
Telephone:  
 Fax:  

Date of Loss:  

Time of Loss:  
Location of Incident/Loss:  
Description of Incident/Loss:  
Were the authorities called:  
Additional Information that might help expedite the claim process:
By clicking submit, I understand this is not an actual claim, but notifying my agent to help my agent with the process of my claim. Note: By submitting this form you understand that no coverage is bound until you receive written notice. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.


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