Request Certificate Your request for a Certificate of Insurance may be submitted in 2 ways: Call us at 800-794-4812. Fill out and submit the online form below. All fields are required. If a field does not apply to you please type NA. Thank you. Account Name Your Name Name of Certificate Holder Street or P.O. Box City, State, Zip Code Attention Fax Number of Certificate Holder Reference Email Comments 11 + 5 = Submit
