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Business Loss Notice
Business Loss Notice

Contact Information
Your Full Name:
(as listed on policy now)
Your Email Address:
Daytime Telephone Number:
Description of Loss
Time & Date of Accident/Claim:
Time AM PM
Date
Location:

Type of Accident/Claim:

Property
Liability
Automobile
Workers Comp
Other:

Description of Loss:

Name(s) of Injured Parties:
Vehicle Description:
(applicable to Auto Claims Only)
Driver Name:
(applicable to Auto Claims Only)
Any Additional Information Not Requested Above
Please Note: Insurance coverage cannot be bound without a written binder from our office.
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Company Partners
Contact Us

Moss Insurance Group
325 Chesnee Hwy
Gaffney, SC 29341

Phone: (864) 489-8121
Fax: (864) 489-8122
General Email: info@mossinsurancegroup.net

Office Hours:
8:30 am - 5:00 pm
Monday thru Friday

Moss Insurance Group have been serving North Carolina and South Carolina since 1976.

© Copyright IMPORTANT NOTE: descriptions of insurance coverage on this web site are for informational purposes only and may not apply, or be included on your policy. Please contact us to confirm coverage provided on your insurance policy or policies your are contemplating purchasing. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.
READ OUR PRIVACY STATEMENT

Some Content Provided By: © Insurance Information Institute, Inc.
Used With Permission ALL RIGHTS RESERVED

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