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File an Auto Claim


Filling out this form does not replace a documented claim. It is used to help expediate your claim. Please contact your insurance agent to file a formal claim.


*Required fields


Contact Information

Your Name:* (As listed on your policy)

Phone Number:*

Email Address:


Description of Loss

Date of accident: (MM/DD/YEAR)*


AM / PM:*


Description of Accident:*

Was the police notified*

Were you ticketed*

If you received a ticket, what for:*

Driver's Name:*

Any additional information:






Our mission at Campbell Insurance is to help guide and educate our clients about insurance to help fit their individual needs.

Treating our clients problems as our own, we are committed to a high standard of customer service.

“It’s my job to find our
customers the right coverage.
What’s the best for them.”

Alexis Chambers

Campbell Insurance Services, Inc. | 416 West Main St. | McNabb, Illinois 61335 | Phone: 815-882-2126