Client Service Request

Client Service Request

Request service for an existing policy or account—choose the help you need and submit your details for review.
Client Information
Full Name

First NameLast Name
Business Name (if applicable)
Mobile Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Is this for a Personal or Business policy?
Policy Type
Insurance Carrier (if known)
Policy Number (if known)
Service Request Type
Policy Change
What would you like changed?
Requested effective date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Description/details of requested change
Upload supporting documents

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Acknowledgement
Certificate of Insurance
Requested wording, endorsements, and coverage requirements are subject to the actual policy terms and insurance carrier approval. A certificate does not amend, extend, or alter coverage.
Certificate holder name
Certificate holder address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Certificate holder email
example@example.com
Job/project name, if applicable
Specific certificate requirements
Additional insured required?
Waiver of subrogation required?
Primary & noncontributory required?
Upload contract, sample certificate, or insurance requirements

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Add or Remove Vehicle / Driver
What do you need to do?
VIN
Year
Make
Model
Vehicle use
Requested effective date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Upload registration, purchase order, lease, or other documentation

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Additional details
Submitting this request does not mean the vehicle or driver has been added to or removed from coverage. Wait for confirmation from Amador Risk Advisors and/or the insurance carrier.
Add or Remove Property / Location
Submitting this request does not automatically add or remove a property or location from coverage. Coverage changes are subject to confirmation.
What do you need to do?
Property/location address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Property/location use
Requested effective date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you own or lease this location?

Other
Occupancy/use details
Brief description of the property/location and operations there
Upload supporting documents, lease, closing documents, property details, or other documentation

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Billing or Payment Question
Policy/carrier involved
What is the billing issue?
Due date, if applicable

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Upload invoice, cancellation notice, billing statement, or other documentation

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Best way to contact you about this issue
Policy Documents
Which documents do you need?

Other
Policy/carrier
Preferred delivery email
example@example.com
Additional details
Coverage Question
Submitting this form does not provide, extend, confirm, or change coverage. Coverage questions are answered based on the actual policy terms, endorsements, underwriting, and carrier requirements.
Which policy or coverage is the question about?
Describe your question or concern
Has something changed recently?
What changed?
Upload supporting document (optional)

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Renewal Review
Which policy is renewing?
Renewal date, if known

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
What has changed since the last review?
Have you had any new exposures since the last review?

Other
What would you specifically like reviewed?
Schedule Your Renewal Review Call
Claim Assistance
**If this is an emergency, first take reasonable steps to protect people and property and contact emergency services when appropriate. Claim reporting requirements vary by policy and carrier. Submitting this form does not constitute confirmation that a claim has been reported to the insurance company or that coverage applies.**
Type of claim

Other
Date of loss

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Brief description
Has the claim already been reported to the carrier?
Carrier claim number, if available
Best number to reach you
Please enter a valid phone number.Format: (000) 000-0000.
Upload photos, notices, reports, or other documents

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Send Documents
What are these documents related to?
Secure file upload

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Optional comments
Other
Please tell us what you need
File upload

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Should be Empty:

Client Service Request

Client Information

Policy Change

Certificate of Insurance

Add or Remove Vehicle / Driver

Add or Remove Property / Location

Billing or Payment Question

Policy Documents

Coverage Question

Renewal Review

Claim Assistance

Send Documents

Other