To submit a claim, simply complete the form below. For questions about claims, call 1-877-210-7401.
For additional information, please see Policy Summary - Terms and Conditions.

File a claim checklist:
Have 30 days passed since you opened your Premium Business Checking Account?

If yes, continue. If no, there is a 30 day waiting period after account opening for mobile phone coverage to start.

Claims should only be submitted on phones that are active as shown on your mobile device wireless bill for the previous month.

Please note: Incidents for accidental damage and mechanical failure that occur prior to, or in the 30 day waiting period are not covered. Please refer to the Policy Summary - Terms and Conditions. for more information.

File a Claim

Policy / Device Information


Claim Information


Contact Information


Enter the name and address of the person we should contact.

Certification Statements


Disclaimer & Digital Signature


 

We must advise you that any person who knowingly and with intent to defraud any insurance company files a statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact thereto, commits a fraudulent insurance act, which is a crime and may be prosecuted to the full extent of the law. By signing, I agree that the statements above are true and correct to the best of my knowledge and cannot be changed once submitted to the company.

 

 



 


Worth Ave. Group - Providing peace of mind to consumers for over 50 years.
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