Fodor Companies
 
3308 Lorain Avenue
Cleveland, Ohio 44113
 
216.631.0116
REQUEST A CERTIFICATE
INSURED INFORMATION...
(* denotes required field)
Policy Holder's Name:
 *
Your Name:
 *
Phone:
 *
Street Address:
   
Fax:
   
P.O. Box/Suite:
   
E-Mail:
   
City:
         
State:
         
Zip Code:
         
CERTIFICATE HOLDER'S INFORMATION...
Certificate Holder's Name:
 *
Attention:
 *
Phone:
   
Street Address:
 *
Fax:
   
P.O. Box/Suite:
   
E-Mail:
   
City:
 *      
State:
 *      
Zip Code:
 *      
SPECIFY COVERAGES
(check all that apply)
SPECIFY INTERESTS OF CERTIFICATE HOLDER
(complete if applicable)
Automobile
Vehicles->
General Liability
Umbrella
Property
Other:
Other:
   
Mortgagee
Loss Payee

Loan Number:

Reference Number or Account Number:

 
Description of Job/Event and/or Special Request:
SEND CERTIFICATE TO...
 
CERTIFICATE HOLDER
Mail
Fax
E-Mail
 
INSURED
Mail
Fax
E-Mail
 
COPY TO
E-Mail Address:
 
 
 
Notifications or changes are not effective until confirmed.
If you do not receive confirmation, please contact Fodor Companies at 216.631.0116.
 
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