Submit a Claim

Our Claims Team is dedicated to providing honest, fair and prompt investigation, handling and disposition of your claim. Please fill out the following form as completely as possible and you will hear from one of our representatives soon. You can also contact us directly:

Northern Insurance Specialists
58 Copperfield Circle, Lititz, PA 17543
Phone: 717-625-0066
Fax: 888-980-1046

Personal Information

First Name*

Last Name*





Primary Phone*

Alternate Phone

E-mail Address*

Policy Number*

Incident Overview

What date did the incident take place?

What vehicle was involved?*

How severe was the damage?*

Is the vehicle drivable?*

Was another vehicle involved?*

Where is the vehicle currently located?*

What is the phone number for the location?*

Incident Location

Street Address

City, State, Zipcode

Incident Description

Describe the Incident