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Auto Accident Claim


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
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Street
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City
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State
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ZIP / Postal Code
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Primary Phone Number
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Alternate Phone Number
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E-Mail Address
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Policy Number
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Incident Overview
What date did the incident take place?
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/ /
What vehicle was involved?
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Was another vehicle involved?
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How severe was the damage?
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Is the vehicle drivable?
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Where is the vehicle currently located?
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What is the phone number for the location?
Optional
Incident Location
Street Address
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City, State. ZIP Code
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Incident Description
Describe the incident.
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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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Map CONTACT INFORMATION
Newbrook Insurance Agency
14 Roosevelt Avenue
Port Jefferson Station, NY 11776
Phone: (631) 473-7059
Fax: (631) 473-7592
Email: info@newbrookins.com

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Newbrook Insurance has been providing insurance to Long Island, including Suffolk County, Nassau County and all of our surrounding towns such as
Port Jefferson Station, Mount Sinai, Miller Place, Setauket, Stony Brook and Coram.