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Polski
1
Are you our client?
YES
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2
Who is our client?
*
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3
What is the name of your business?
*
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4
Can you upload or take a picture of the Certificate Request?
YES
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5
Please upload requirement documents or a picture.
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Max. file size
: 10.6MB
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6
Certificate Holder Information
*
This field is required.
Certificate Holder Name
Address
City
State
Zipcode
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7
Does the Certificate Holder need to be listed as additional insured?
*
This field is required.
YES
NO
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8
Can you upload what needs to be listed as additional insured?
YES
NO
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9
Who needs to be listed as additional insured?
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10
Please upload any wording or contract requirements
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Max. file size
: 10.6MB
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11
Where should we send this certificate?
Email Address:
example@example.com
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