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    WELCOME TO OUR INSURANCE

    CERTIFICATE REQUEST PORTAL

     

     

    THROUGH THIS ELECTRONIC FORM YOU WILL BE ABLE TO SUBMIT A REQUEST FOR A CERTIFICATE OF INSURANCE. PLEASE NOTE: THAT INSURANCE COVERAGE CANNOT BE BOUND OR CHANGED VIA SUBMISSION OF THIS ONLINE FORM. INSURANCE COVERAGE DOES NOT GO INTO EFFECT UNTIL CONFIRMED AND APPROVED BY THE INSURANCE CARRIER(S).

    ALL COVERAGES ARE SUBJECT TO THE TERMS, CONDITIONS, AND EXCLUSIONS OF THE ACTUAL POLICY ISSUED, AND NOT ALL POLICIES OR COVERAGES ARE AVAILABLE IN EVERY STATE.

    IN ORDER TO PROTECT YOUR PRIVACY, PLEASE DO NOT SEND US ANY CONFIDENTIAL OR PERSONAL INFORMATION BY THIS ELECTRONIC FORM, EMAIL OR FAX, INSTEAD DISCUSS SUCH INFORMATION WITH ONE OF OUR AGENTS BY PHONE OR IN PERSON

    PLEASE CONTACT OUR OFFICE AT 678-904-1642 EMAIL AT SUPPORT@MYATLAGENCY.COM IF YOU HAVE QUESTIONS ON AN SPECIFIC COVERAGE, FORMS & POLICY LIMITS.

     

                                                                                                                         THANK YOU!
                                                                                                                                                                                           ATL INSURANCE

  •  BY CLICKING "AGREE & CONTINUE" I CERTIFY THAT:

    • ALL INFORMATION THAT I WILL PROVIDE IS CORRECT AND TO THE BEST OF MY KNOWLEDGE.
    • I UNDERSTAND THAT NO COVERAGE IS BOUND ON ANY INSURANCE COVERAGE UNTIL CONFIRMED IN WRITING BY OUR AGENCY IF ENDORSEMENTS AND/OR CHANGES ARE REQUIRED.
    • ENDORSEMENTS, FORMS AND/OR SPECIAL WORDING MAY REQUIRE ADDITIONAL PROCESSING TIME AND/OR FEE.
    • CORRECTLY COMPLETED CERTIFICATE REQUESTS WILL BE PROCESSED IN A SHORTER TIME.
  •  1. CLIENT / POLICY HOLDER INFORMATION:

    Fields marked (*) are mandatory.

  •  2. CERTIFICATE HOLDER INFORMATION

    COMPANY REQUESTING TO VERIFY COVERAGE(S)

  • ADDITIONAL INSURANCE ENDORSEMENT FORM

    CGL FORM GC 2010
  • PREMIUM MAYBE AFFCTED BY THE ENDORSEMTNS AND SPECIAL FORMS  

     

     

     

     
  •  3. ADDITONAL INSURED SECTION

     

  •  3. ADDITONAL INSURED(S) FORMS

     


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  •   4. VERIFICATION OF COVERAGE REQUEST

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