Carter & Company, L.L.P. 

 

 

 

Certificate of Insurance Request Form

Named Insured (Your Organization):

Today's Date:

Date Certificates Needed:

Certificate Holder Name:

Street Address:

City:

 State: Postal Code:

Fax Number:

Telephone:

Email Address:

Additional Insured:

On occasions, the name of another party or interest needs to be added to your policy as an Additonal Insured.  If this is needed, please provide the following information:

The interest of the Additional Insured is that of a:

Landowner Customer Lienholder Other  If other, please describe

If you ned the Certificate of Insurance immediately, please submit this form to us by clicking the "Submit" button below:
If you prefer to fax or mail the form to us, just complete it in it's entirety, print and fax to 830-875-9362 or mail to:

Carter and Company, LLP
P.O. Box 672
Luling, TX  78648

When your request is received in our office, we will issue the Certificate of Insurance within 24 hours.  Please indicate below how you would like certificates sent:

To Them

Copy To You
By Fax By Fax
By Mail By Mail

 

 

Send mail to info@cartercompany.com with questions or comments about this web site.