If you would like to request a certificate of insurance please complete the form.

We will be able to comply with most requests within 24 hours.  If you need an immediate response, please call our office.


 

Stewart, Brimner and Lear

Request for Certificate of Insurance

Fax: 260-347-3119
Please provide the following information:
   
  Requested By:  
 

Business Name

First Name

Last Name

Work Phone

Home Phone




     
  Certificate Holder:  
Name
Street Address
City
State/Province
Zip/Postal Code
E-mail





     
  INTEREST Please describe their interest:
     
 
Certificate Holder (no additional charge)
Additional Insured (may result in additional charge)
Loss Payee
Mortgagee
Other (explain)




     
  Fax to: Attention to
    Fax #
     
Mail the certificate:
Special Instructions
     
      

 


 

 
 

 

303 E. North Street
PO Box 217
Kendallville, IN  46755
Phone 260-347-1352
Fax 260-347-3119

Ligonier, IN  46767
Phone 260-894-4191
Fax 260-347-3119

Site Hosted and Managed by
Technology Specialists