Loss Run Request for Agents

Please complete the form below to request a Loss Run report.

Requests for Loss Run reports generally take between 24-48 hours to process. If you have any questions, please email info@brownyard.com.

Insured Company Name:

DBA Name:

Insured City / State:

City State

Policy #:

Policy #

Policy Effective Date (mm/dd/yyyy)

Policy Expiration Date (mm/dd/yyyy)

Can add up to 5

Date Range:

Start Date:

End Date:

Contact Information of Person Requesting Runs

Name:(Required)

First Last

Company/Agency:

Email:(Required)

Notes:

CAPTCHA

NOTE: If the person requesting the loss runs is not the Named Insured or Broker who insures the policy, Brownyard Group will need written authorization from the insured authorizing Brownyard to release loss runs.

Please complete the form below to request a Loss Run report.

Contact Information of Person Requesting Runs

About Us:

Programs:

For Agents:

Contact Us: