Contact Us

Contact Information Form
 

The Contact Information Form is to be used for general questions or inquiries only in regards to insurance-related issues. Do not use this form to file a complaint.

              *** This form is not to be used by agents or brokers for licensing inquiries ***

  • Click on Licensing if you're an agent or broker inquiring about your licensing information
  • If you are a consumer and want to file a complaint, click on Consumer Request for Assistance
  • If your inquiry is time-sensitive and you need immediate assistance from a Department of Insurance Compliance Officer, please contact the Consumer Hotline at 800-927-HELP (4357) or (213) 897-8921, or
  • If you prefer to contact us online with your question or inquiry, please continue by completing this form. When you have completed all the *required fields, please press SUBMIT. To start over, please press RESET.

*First Name: *Last Name:  
 
*I am a(n):
 
*Mailing Address:  
 
Suite/Apt#:    
 
*City: *State: *Zip Code:
 
*Daytime Phone Number: *Email Address:  
( ) - ext.
 
*Type of Insurance Involved:    
   
 
*Briefly describe your question or comment: 500 character limit  
 

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