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Property Loss Claim Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Personal Information
First Name
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Last Name
Required
Street
Required
City
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State
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
Alternate Phone Number
Optional
E-Mail Address
Required
Policy Number
Required
Loss Overview
Loss Type
Required
What date did the incident take place?
Required
/ /
How severe was the damage?
Required
Describe the Loss
Required
Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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235 Wayne Road
Savannah, TN 38372
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Office: 731.926.1200
Fax: 731.925.9059
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The Hardin County Bank Insurance is a division of The Hardin County Bank. Insurance products offered are not a deposit, not FDIC- Insured, not insured by any federal government agency, not guaranteed by the Hardin County Bank, and may go down in value.
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