Call Us Today: (631) 425-8800
Call Us Today: (631) 425-8800

Multi Placement Form

Multi-Placement Form

Multiple Claim Form

You can submit multiple claims by putting the claim information in this Excel spreadsheet then upload and submit below or e-mail to newclaims@agaltd.com. Supporting documents may also be uploaded and submitted using this form. Please supply enough information so we know which claim your follow up documents correlate to.

If you have any questions on claim submission please be sure to contact us at (631) 719-8028.

File Attachments

Please submit any contracts, notes, returned checks, itemized statements or other papers that are needed. When necessary, you are authorized to forward this account, under bond, to a commercial attorney.

Drop a file here or click to upload Choose File
Maximum upload size: 10MB

You may attach up to 5 files (10MB each) to this submission.
Acceptable file formats include MS Word/Excel, Apple Pages/Numbers, PDF and Zip files.