File a Claim

Contact Information
First Name
Last Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Mailing Address / PO Box

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address
example@example.com
Primary Phone
Format: (000) 000-0000.
Secondary Phone
Format: (000) 000-0000.
Person Reporting
Same as above
Reporter's First Name
Reporter's Last Name
Reporter's Primary Phone
Format: (000) 000-0000.
Reporter's Secondary Phone
Format: (000) 000-0000.
Incident Information
Date of Incident

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time of Incident

Hour Minutes

AM/PM Option
Is location of Incident same as Mailing Address?
Address of Incident

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Was a PGE vehicle involved?
PGE Driver (if known)
PGE Vehicle ID (if known)
Was a non PGE vehicle involved?
Make
Model
Year
Where is the damage
In detail, explain what happened.
Property Damage
Are you the owner of the damaged property?
Property Owner Name
Property Owner Primary Phone
Format: (000) 000-0000.
Injuries
Did any injuries occur?
Name of Injured Party
Were there witnesses?
Witness Name
Witness Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Witness Phone
Format: (000) 000-0000.
Insurance Info
Have you contacted your insurance company? (informative information only)
Insurance Company
Claims Adjuster
Insurance Phone
Format: (000) 000-0000.
Please provide us with copies of repair estimates, invoices, proof of purchase, photos and/or other supporting documentation. Please compile your documentation into one document smaller than 10 megs. Our investigation of your claim is not an admission of liability or an indication that PGE is responsible for your damages.
Attach a File

Cancelof
I understand that all documentation submitted in support of this claim will be reviewed by Portland General Electric. I certify that the foregoing is true and correct.
Should be Empty:

Contact Information

Person Reporting

Incident Information

Property Damage

Injuries

Insurance Info