Form Sent Successfully!

Thank you for taking the time to fill out our form.
It has been sent to our staff and will receive prompt attention.

Learn more about our agency
See which insurance companies we represent
Contact our customer service staff
Visit our resource library
Return to our home page

 

Request a Certificate of Insurance

A Certificate of Insurance is a listing of the insurance coverage you have currently purchased. It is usually by someone who is hiring you to perform a task. This page is intended for contractors only.

If you are looking for assistance with any other business or personal insurance needs, please contact us. To request a commercial Certificate of Insurance, please fill out the following form:
Insured's Name
Email Address REQUIRED
Name of Certificate Holder
Street Address
City, State & ZIP Code
Job Name/Property Name
Location Address
Certificate Holder
"Named Additional Insured"
Additional Requirements
Handling Instructions
Comments
 

Request an Auto ID Card

Insurance ID cards are included for each insured vehicle with each new or renewal policy sent to you in the mail. A new ID card will automatically be sent to you for each new vehicle you add to your policy. If you buy a new or used car, the dealership will require proof of auto insurance before you leave the lot. In most states, you can use a current policy declarations page or ID card for another vehicle as valid proof of insurance for a minimum of 14 days until you receive your ID card in the mail.

If you have misplaced the ID card for your vehicle, please fill out this simple form as completely as possible. Our staff will verify your coverage, then send the replacement card according to your instructions on this form. For immediate assistance, you are advised to call our office during normal business hours and speak with a licensed representative who can generate the ID card for you.

General Contact Information
Contact Name:
Email Address REQUIRED
Phone Number:
Fax Number:
 
Policyholder Information
Insured Name:
VIN or Serial #:
Address:
City or Town:  
State:
ZIP Code:
Handling Instructions:
Additional Comments:
 

Email Address Required

We require your email address
in order to process your form.

Please press your BACKSPACE key
to return to the partially-completed form.

 

Request a Free Insurance Quote

We are happy to answer any questions or provide you with additional information about our insurance coverages or our agency.

You can contact us by telephone at 318-336-5202 in Vidalia or 318-757-4780 in Ferriday.

You can also fill out this simple online form and we'll contact you to gather personal information needed to provide an accurate estimate of your insurance coverage:

General Contact Information
Contact Name
Company
Email Address REQUIRED
Street Address
City, State & ZIP Code
Telephone
(including area code)

Cell    Home    Work
Additional Comments
 
  Which type(s) of insurance are you interested in?  Please check all that apply.
Personal Personal Auto
Homeowners
Umbrella
Recreational Vehicles
Flood Insurance
Earthquake Insurance
Term Life Insurance
Individual Health Insurance
Family Health Insurance
Other (show in Comments)
 
Business Business Insurance
Commercial Property
General Liability
Recreational Vehicles
Professional Liability
Excess Liability
Workers' Compensation
Group Life Plans
Group Health Plans
Other (show in Comments)
 
 

More Articles ...