Phone: 606-474-5128
Fax: 606-474-5001
Email: info@millerins.net
Hours: Mon-Fri 9-5pm, Sat: 9-12pm
210 South Carol Malone Blvd
Grayson, KY 41143

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Policy Holder Information
Name of Insured
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Home Phone
Work Phone
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Time and Description of Loss
Date
Time of Loss


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Location of Property
Description of Loss
Authority Notification
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If Yes, which Authority?
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Is the Property habitable?
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If No, where are you staying?
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