Certificate of Insurance Request Form | Summer Insurance Agency, Newberry SC 803-276-8500


	2620 Main Street Newberry, SC 29108 803-276-8500 803-276-8504 fax Email Us

Certificates of Insurance

A certificate of insurance is a listing of the insurance coverage that you currently have in force. It is usually requested by someone who hires you to perform a task. If you have any questions about your coverage, please contact us at 803-276-8500.

To request a certificate, please fill out your information in the space listed below and click on the Submit button.

REQUESTED BY
Date
Contact
Email Address
Insured Company
Street Address
City or Town
State	ZIP Code:
SEND TO
Name of Certificate Holder
Attention
Street Address
City or Town
State	ZIP Code:
Is the Certificate Holder named as Additional Insured? Yes No

DELIVERY METHOD
Email
Fax Number	(including area code)
Additional information and/or special instructions

Summer Insurance Agency, LLC is licensed in the state of South Carolina only.
Summer Insurance Agency, LLC is not able to discuss or sell to individuals or entities outside the state of South Carolina.
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