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After you have completed the form in its entirety, please print and sign the document before faxing it to our office. If you choose to submit the form via e-mail, you must have the capability of producing an authentic electronic signature, as all forms require an original signature.
Fax the forms to: (304)876-3530.

Disclaimer:
Any changes requested on this website are NOT official until you receive written confirmation from The Hoxton Agency, Inc.

All fields are required. Personal Details

Caller: Caller's Phone: Policy Owner: Policy Owner's Phone: Pilot: Pilot's Phone: Aircraft N#:

Incident Details

Date of Loss: Time of Loss: Description of Loss: Damage to Aircraft? Yes No Property Damage? Yes No Bodily Injury? Yes No

Call Back Details

Call Back Contact Name: Call Back Phone: Call Back Email: