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Client Central

Business Clients

Add / Change Insured Location

To request a Location Change...
you may call our office, send a fax, or complete the following form. If you prefer to call or fax us, you may use this form as a guide to the kinds of information we will need to process your request. To request via this website, please complete as much of the following form as possible. When you hit the SUBMIT button, your request will be delivered via email to our customer service department for immediate attention. When handled, you will receive confimation from us by mail, unless you have requested a faxed or emailed confirmation.

(Required *)
Business Account Name: *
Insured Name: *
Name/Phone # of Contact Person: *
Add New Location Effective:
Delete Current Location? No Yes
If Yes, Address of Location to Delete:
Effective Date to Delete Location:
Use New Location for Mailing: No Yes
 

New Location Information

Location Address/Street:
City/State/Zip:

Office Location/Building Information

Construction:
Number of Stories:
Year Built (approx.):
Your Square Footage:
Owner? No Yes
Tenant? No Yes
Alarm? No Yes
Sprinklers? No Yes

Coverage Limits Requested:

Please consult the requirements of your lease when choosing the coverage and limits for this location.

 

Contents:

Contents should include the following:

Leasehold Improvements
Leased Property
Inventory
Furniture/Fixtures
Equipment
Printed Material
Consumables
Property of Others

Building:
Computer Hardware:
Computer Software:
Valuable Papers:
Accounts Receivable:
Other Contents:
Business Income:
Exterior Glass Coverage Needed? No Yes
Exterior Sign Coverage Needed? No Yes
Does landlord want a certificate of insurance? No Yes
Does landlord want to be listed as additional insured? No Yes
Additional Payroll for this Location?

Comments or Additional Information:

        

 

 



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20251 Century Blvd | Suite 425 | Germantown, MD 20874
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