Saturday, September 04, 2010   
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Customer Service
Request a Certificate of Insurance
Your Name:
E-mail Address:
Telephone Number:
Policy Number:
Named Insured:
Certificate Information:

Name of Additional Insured/Certificate Holder:

Address

City, State, Zip


Project Name/Description:


Special language requirements or instructions regarding this certificate:


Is a License or Permit Bond Required?
No    Yes  Limit:

How should this certificate be handled?

Please mail the certificate to me.
Please mail to the certificate holder at the address indicated above.
I will pick up the certificate at your office.
Please fax the certificate to:
       Fax Number:                 Attn:
          
Please mail to the person/persons indicated below.
       Name:
       
       Address:
       
Please call me for instructions.
If you have not received a response from us within one business day, please contact us again.
Winters Insurance Group  //  5556 Cheviot Rd., Suite B, Cincinnati, OH 45247  //  513-662-4800 • 513-662-1653 Fax
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