Wallach & Company, Inc.

107 West Federal Street

Post Office Box 480

Middleburg, Virginia 20118-0480 USA

(800) 237-6615 or (540) 687-3166

Fax: (540) 687-3172

Email: info@wallach.com


Claim Form

Claim Form

The medical expense claim form needs to be printed out and mailed to Wallach & Company, Inc. along with ORIGINAL charges. Emails or faxes of the charges will not be accepted.

Download Claim Form