At Cook, Disharoon & Greathouse, we strive to provide you with the best customer service so you have prompt, thorough help when you need it. This online support system, when paired with our customer service representatives, is designed to help you keep in control of your policies and your claims. If you need to make a change to your coverage, this is where to do it.

If you need assistance after business hours, please call the insurance company listed on your policy or head to our
Payment & Claim Center. Your policy will list a 24-hour claim reporting number, or you can find those numbers in our Payment & Claim Center. Before you call, get your policy number ready. Alternately, you can call us at (510) 437-1900 to report a claim.

Please note that coverage cannot be bound by email, voice, or fax. Coverage will only be bound with written notification from our office.

If you experience a loss, we’re here to help!

Change of Address Form





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Old Address




New Address








Auto ID Card Request






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Number of Vehicles to Order Cards For:


Send Cards to...







Certificate of Insurance Request





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Account Holder






Certificate Recipient










Certificate Information











Online Claim Form










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Were the Authorities Called?


By clicking submit, I understand this is not an actual claim, but notification to my agent to help with the process of my claim.


Policy Change Request





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Policy Change Information






Remove Vehicle Request Form







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Vehicle Information

Number of Vehicles to Remove

Vehicle 1




Vehicle 2




Vehicle 3




Vehicle 4




Vehicle 5




Add Vehicle Option

Number of Vehicles to Add:

Vehicle 1:







Ownership:

Primary Use::

Anti Theft Features:

Passive Restraints:

Anti-Lock Brakes:

Daytime Running Lights:

Any Prior Damage to Vehicle?

Vehicle Ever Used for Deliveries?

Comprehensive Deductible:

Collision Deductible:

Full Glass Coverage?

Addition Effective Date

Vehicle 2:







Ownership:

Primary Use::

Anti Theft Features:

Passive Restraints:

Anti-Lock Brakes:

Daytime Running Lights:

Any Prior Damage to Vehicle?

Vehicle Ever Used for Deliveries?

Comprehensive Deductible:

Collision Deductible:

Full Glass Coverage?

Addition Effective Date

Vehicle 3:







Ownership:

Primary Use::

Anti Theft Features:

Passive Restraints:

Anti-Lock Brakes:

Daytime Running Lights:

Any Prior Damage to Vehicle?

Vehicle Ever Used for Deliveries?

Comprehensive Deductible:

Collision Deductible:

Full Glass Coverage?

Addition Effective Date

Vehicle 4:







Ownership:

Primary Use::

Anti Theft Features:

Passive Restraints:

Anti-Lock Brakes:

Daytime Running Lights:

Any Prior Damage to Vehicle?

Vehicle Ever Used for Deliveries?

Comprehensive Deductible:

Collision Deductible:

Full Glass Coverage?

Addition Effective Date

Vehicle 5:







Ownership:

Primary Use::

Anti Theft Features:

Passive Restraints:

Anti-Lock Brakes:

Daytime Running Lights:

Any Prior Damage to Vehicle?

Vehicle Ever Used for Deliveries?

Comprehensive Deductible:

Collision Deductible:

Full Glass Coverage?

Addition Effective Date


Add Driver Request Form







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Driver Information

Number of Drivers to Add:

Driver 1



Driver 1 Gender:

Marital Status:

Relation to Applicant:

License Status:

License State:


Suspended in Last 5 Years:

Occupation Industry:



Accidents Within 5 Years?:

Violations Within 5 Years?

SR22 Filing?

Eligible For Good Student Discount?

Eligible For Defensive Driver Discount?

Eligible For Drivers Ed Discount?

Driver 2



Driver 2 Gender:

Marital Status:

Relation to Applicant:

License Status:

License State:


Suspended in Last 5 Years:

Occupation Industry:



Accidents Within 5 Years?:

Violations Within 5 Years?

SR22 Filing?

Eligible For Good Student Discount?

Eligible For Defensive Driver Discount?

Eligible For Drivers Ed Discount?

Driver 3



Driver 3 Gender:

Marital Status:

Relation to Applicant:

License Status:

License State:


Suspended in Last 5 Years:

Occupation Industry:



Accidents Within 5 Years?:

Violations Within 5 Years?

SR22 Filing?

Eligible For Good Student Discount?

Eligible For Defensive Driver Discount?

Eligible For Drivers Ed Discount?

Driver 4



Driver 4 Gender:

Marital Status:

Relation to Applicant:

License Status:

License State:


Suspended in Last 5 Years:

Occupation Industry:



Accidents Within 5 Years?:

Violations Within 5 Years?

SR22 Filing?

Eligible For Good Student Discount?

Eligible For Defensive Driver Discount?

Eligible For Drivers Ed Discount?

Driver 5



Driver 5 Gender:

Marital Status:

Relation to Applicant:

License Status:

License State:


Suspended in Last 5 Years:

Occupation Industry:



Accidents Within 5 Years?:

Violations Within 5 Years?

SR22 Filing?

Eligible For Good Student Discount?

Eligible For Defensive Driver Discount?

Eligible For Drivers Ed Discount?


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If you have any questions feel free to contact us at any time, we’re happy to help!
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Website Disclaimer – Review Carefully:

This information is not an offer to sell insurance. Insurance coverage cannot be bound or changed via submission of this online form/application, e-mail, voice mail or facsimile. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed directly with a licensed agent. Note any proposal of insurance we may present to you will be based upon the values developed and exposures to loss disclosed to us on this online form/application and/or in communications with us. All coverages are subject to the terms, conditions and exclusions of the actual policy issued. Not all policies or coverages are available in every state. You also agree to release us from any liability if this information is accidentally viewed by unauthorized persons. We will only use this information for insurance quoting purposes and not distribute to other parties.

Our Companies

Cook, Disharoon & Greathouse is proud to offer coverage through some of the most distinguished, highest rated insurance companies in our industries. We have partnered with multiple companies so we can provide you with multiple quotes and options, ensuring you get the best policy at the best price.