Hanover Referral
Primary Contact Name
*
First
Last
Email
Phone
Mobile
Relationship to Policy Holder
*
Policy Holder
Insurance Agent
Business Agent
Property Manager
Personal Assistant
General Contractor
Plumber
Family Member
Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Rep Email
*
Select your email below
ebutts@hanover.com
rdawson@hanover.com
sheintz@centralbnkinsurance.com
Rep Notification Email
Role
None
Claims Adjuster
Claims Rep
Risk Consultant
Policy Number
Type
*
None
Pre-Loss
Post-Lost
Type of Loss (if applicable)
None
Water Damage
SUMP Pump
Primary Cause of Damage (if applicable)
None
Pipe failure
Appliance failure or supply line break
Plumbing fixture leak or malfunction
Flooding due to blockage or backup
Human error
SUMP - Primary failure
SUMP - Primary & Secondary pump failure
SUMP - Loss of Power (no battery backup)
SUMP - Insufficient backup power
SUMP - too much water
SUMP - Drain backed up
Other:
Claim Number (if applicable)
SUMP Failure (if applicable)
None
None
Primary & Secondary pump failure
Loss of Power (no battery backup)
Insufficient backup power
Too much water
Drain backed up
Primary pump failure
Qualify for the leak prevention benefit?
None
Yes
No
Not sure
Benefit amount is
None
$2500
Description
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English
French
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