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Form analysis
1 forms found in the DOM

POST ./

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  <div>
    <table class="nav" cellspacing="0" cellpadding="10px">
      <tbody>
        <tr>
          <td class="navlogo">
            <img src="images/ahue.png" id="logo" alt="AHIC">
          </td>
          <td class="navtext">Report a Claim</td>
        </tr>
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    <div id="ClaimTypePanel" onkeypress="javascript:return WebForm_FireDefaultButton(event, 'SearchButton')">
      <br>
      <br>
      <br>
      <table class="fnol_center">
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          <tr>
            <td>
              <h2>You may report a claim online if:</h2>
              <hr>
              <ul>
                <li>You are listed on the American Heartland or United Equitable Insurance Company policy.</li>
                <li>You have been involved in a collision with a(n) American Heartland or United Equitable policyholder.</li>
                <li>You are the American Heartland or United Equitable policyholder's agent, assisting them with their claim.</li>
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              <hr>
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          <tr>
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                  <tr>
                    <td style="white-space: nowrap">
                      <h3>How are you involved in this claim?</h3>
                    </td>
                  </tr>
                  <tr>
                    <td style="white-space: nowrap">
                      <select name="ClaimType" onchange="javascript:setTimeout('__doPostBack(\'ClaimType\',\'\')', 0)" id="ClaimType">
                        <option selected="selected" value="Select">Please Select</option>
                        <option value="Insured">I am insured by American Heartland or United Equitable Insurance Company.</option>
                        <option value="Claimant">My vehicle collided with an American Heartland or United Equitable vehicle.</option>
                        <option value="Agent">I am an Insurance Representative/Agent.</option>
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Text Content

Report a Claim







YOU MAY REPORT A CLAIM ONLINE IF:

--------------------------------------------------------------------------------

 * You are listed on the American Heartland or United Equitable Insurance
   Company policy.
 * You have been involved in a collision with a(n) American Heartland or United
   Equitable policyholder.
 * You are the American Heartland or United Equitable policyholder's agent,
   assisting them with their claim.

--------------------------------------------------------------------------------


HOW ARE YOU INVOLVED IN THIS CLAIM?

Please Select I am insured by American Heartland or United Equitable Insurance
Company. My vehicle collided with an American Heartland or United Equitable
vehicle. I am an Insurance Representative/Agent.