File a Claim

Contact Information
First Name*
Last Name*
Date of Birth

MonthDayYear
Date
Mailing Address / PO Box*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email Address
example@example.com
Primary Phone*
Secondary Phone
Person Reporting
Same as above

YesNo
Reporter's First Name*
Reporter's Last Name*
Reporter's Primary Phone*
Reporter's Secondary Phone
Incident Information
Date of Incident*

MonthDayYear
Date
Time of Incident*

Hour Minutes

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

YesNo
Address of Incident*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Was a PGE vehicle involved?

YesNo
PGE Driver (if known)
PGE Vehicle ID (if known)
Was a non PGE vehicle involved?

YesNo
Make
Model
Year
Where is the damage
In detail, explain what happened.
Property Damage
Are you the owner of the damaged property?*

YesNo
Property Owner Name
Property Owner Primary Phone
Injuries
Did any injuries occur?*

YesNo
Name of Injured Party
Were there witnesses?*

YesNo
Witness Name
Witness Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Witness Phone
Insurance Info
Have you contacted your insurance company? (informative information only)

YesNo
Insurance Company
Claims Adjuster
Insurance Phone
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.

I agree
Should be Empty:

Contact Information

Person Reporting

Incident Information

Property Damage

Injuries

Insurance Info