Auto Loss Notice 

Automobile 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 of Accident:


 
Description of Accident:
 
Police Notified?:
Yes No
 
Were you ticketed?:

Yes No

 
If you received a ticket, what was it for?:
 
Driver Name:
Any Additional Information Not Requested Above:
Please Note: Submitting this form via the website does not constitute a "formal" claim. Please contact us or your insurance company to notify of a loss.

Enter the security code you see above. Code is NOT case sensitive. *

Site Mailing List 
Serving Virginia For Over 140 Years!

PO Box 306
1404 South Main
Farmville, VA 23901
Phone: 434-392-5405
Email: info@harwoodins.com



 

 

Powered By:
Insurance Web Designs
websites for insurance agents


 

Community Involvement:

  • Board of Trustees, Hampden Sydney College 2000 – 2013
  • Board of Trustees Randolph-Macon Academy 2002 - 2004
  • Board of Directors, 1st National Bank of Farmville/1st Virginia Bank 1980-1995
  • Virginia Commission of State and Local Governments’ Responsibility and Taxing Authority 1995 – 1996*
  • Commission on the Future of Higher Education in Virginia*
  • Tobacco Indemnification and Community Revitalization Commission 2005 – 2009**
  • Chairman, Prince Edward County United Way, 1988
  • Chairman, Poplar Hill Community Development Authority 2000 – 2004
  • President, Randolph-Macon Academy Alumni Association 2002 – 2004
  • YMCA
  • Farmville Area Chamber of Commerce
  • Farmville Jaycees
  • Farmville Rotary Club
  • Mission work in Honduras
  • Farmville Lions Club
  • Farmville Masonic Lodge
  • Longwood College Center For the Visual Arts
  • Southside Virginia Red Cross
  • Active annually in state and federal lobbying for client and industry advocacy.
  • Veterans of Foreign Wars, Life member
  • Insurance Education for Habitat For Humanity Recipients

 

*Appointed by Governor George Allen
**Appointed by Governor Mark Warner