* Certificates are normally processed in two to five days business days. Requests are prioritized by date needed and event date.

* Please allow two weeks for Certificate requests. This processing time includes correction of any errors or making changes that are required by the venue.

* Complete all the fields below. Print a copy for your records and hit the "email form" button. This request is delivered to a dedicated processor who will send you a PDF back of the certificate you requested.  Your PDF will also be faxed or emailed to whomever you request on your request form.

Certificate Request Form:
Member's Legal Name
Insured's First Name:
A value is required.
Insured's Last Name:
A value is required.
Email Address:
A value is required.
Business or Performer Name:
A value is required.
Certificate Holder
(Venue where you are performing)
Venue Name:
A value is required.
Attention:
A value is required.
Venue Address:
A value is required.
City:
A value is required.
  State:
A value is required.
Zip Code:
A value is required.
Additional Insured:
Event Date:
Date Needed By:

Note: A minimum of 48 hours is required
Fax Number (where certificate should be sent):
Email for event:
Attach a file:
Please check if you're using an Apple product to view PDF files:
Enter your email address here if you would like a confirmation sent to your email account.
 
     
 
 
Website Design By: Noah Zenzen
Specialty Insurance Agency
Performers of the US & Vendors of the US
PO Box 24
New Richmond, WI 54017
Ph: 715.246.8908
Fax: 715-246-4257
info@specialtyinsuranceagency.com