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"Request Insurance Certificate"
Online Order Form
One Simple Form - takes only 2-3 Minutes!
Your Personal Data

Your Name
Street Address:
City:
State: (Must be Wisconsin)
Zip/Postal:
E-Mail (REQUIRED):
Phone (REQUIRED):
Fax: (Optional)
 
Certificate Request Details
(You Must Complete ALL Information Below)
 
Your Policy Number:
 
Location of Job/Project:
 
Detailed Description of Job/Project:
 
Which do you need? Certificate of Insurance ONLY
-or-
Certificate of Insurance WITH Additional Insured Endorsement
 
Additional Wording Required? (If so, list here):
 
 
Name and Address of Additional Insured:
 
Coverage Requested: General Liability
Workers Comp/DBL
Auto
Other
 
Delivery Instructions:
(If Faxing, fill in fax info in following question)		 Mail to Certificate Holder
Fax to Certificate Holder
Fax to My Office
Someone Will Pick Up ASAP
Mail to My Office
 
Fax Number Where
Certificate Should be
Faxed To:
 
What is this party's insurable interest to you as named insured (i.e., landlord, permit, for job, etc.)
 
What is the Additional Insured's relationship to job being performed? (i.e. Owner, managing agent, lessor, general contractor, etc.)

Thank you for filling out this form COMPLETELY!

We deem your data submitted as PRIVATE information. Every step has been taken to insure your privacy, security, and to release this information only to you. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Also, the insurance carriers reserve the right to issue coverage or not, and we cannot guarantee acceptance of a risk until approved by the company.

NOTE: IF THERE IS A CHARGE FOR YOUR CERTIFICATE, WE WILL CALL YOU FOR CREDIT CARD INFORMATION TO ORDER YOUR CERTIFICATE.

Yes, Please Service My Account. I Understand that NO COVERAGE IS BOUND on insurance changes until confirmed IN WRITING BY OUR AGENCY.

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BADGER INSURANCE ASSOCIATES:


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Local Office Phone: 608-831-3797
Office Fax: 608-831-5740
Email: markh@badgerinsurance.com
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Badger Insurance Associates and WI-contractors-Insurance.com has been insuring Wisconsin contractors for decades. We shop the current major contractor insurance carriers to get you the maximum protection at the most affordable prices. We present FAST quotes, GREAT service, and LOW rates to every customer. Some of the KEYWORDS our clients use to find us on the internet include: Wisconsin contractor insurance, WI contractor's insurance, Wisconsin contractor general liability insurance, contractors insurance, artisan insurance, WI contractor general liability insurance, Wisconsin artisan general liability insurance, low cost WI contractor's insurance, contractor insurance quote, Wisconsin contractor liability insurance, WI contractor's business insurance, and more.

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