Buckland Insurance Agency, Inc.
Since 1979... Serving our community for 30 years.
Home
 Contact Us
 Online Services
 Client Services
 Resources
Add us to your Favorites

Request Certificate of Insurance


 
Certificate of Insurance Request:
 
 
* Required Fields
*Policy Holder Name:
*Name as you want it to appear on certificate:
*Address  
*Street:
*City:
*State:
*Zip
*Phone Number:
*Which Year? Current Year Prior Audit Year
*Method of Delivary:  
Fax
Email:
Mailed to address above:
Special Instructions:

  Please Note: Due to the fact that we cannot control the message delivery and retrieval time of e-mail, we must view e-mail in the same category as a voice mail message. Leaving a message on e-mail, voice mail, or facsimile systems does not constitute the binding or altering of coverage in any way. You must obtain verbal or written confirmation of binding or altering coverage. Feel free to call a Buckland Insurance representative with any questions. Thank you.