If you are a Virginia Farm Bureau policyholder you may use this form to submit a claim. If your policy is in another state, please use the American Farm Bureau web site to locate your State Farm Bureau office. Your Claim Type of Claim* -Select a claim type- Auto Home Farm Windshield Policy Number* Name of Policy Holder* Date of Loss* Select Date Provide a brief description of this claim* (Maximum 500 words.) About You Prefix -Select a prefix- Mr. Mrs. Miss Ms. Dr. Rev. First Name* Last Name* Address & Contact Mailing Address* Mailing Address 2 City* State* Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip Code* Daytime Phone* Mobile Phone Email* Best Time to Contact You? (Service Desk Hrs 7:30 am - 6:00 pm)* -Select a contact time- Morning Afternoon Evening Captcha Image (Security Code)*