Submit a Claim

CPC Insurance Claim Form

First Name

Last Name

Daytime Phone

Account Number

VEHICLE LOSS INFORMATION

Vehicle Year

Vehicle Make

Vehicle Model

Last 6 of VIN #

Current Miles

Date of Loss

Were you at fault in the accident?

Yes

Address where loss of vehicle occurred

City

Zip Code

Is the vehicle drivable?

Yes

Location of Vehicle / Towing Company

Address

Address Line 2

City

Zip

Phone number of towing company

In your own words, describe how loss occurred:

Police Report

Yes

If yes, please include Police Report number

Please upload clear photographs of all damaged areas of the vehicle

Upload

or Drag and Drop a File

** Please note : Our team will contact you within 24 - 48 hours to discuss your claim.

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WE SERVICE THE STATE OF MICHIGAN ONLY AND ADHERE TO ALL LENDING LAWS IN THE STATE OF MICHIGAN.