Mobile Certificate Request Form Logo

  • CERTIFICATE OF INSURANCE REQUEST

    MOBILE PORTAL

     

  • WELCOME TO OUR ONLINE INSURANCE SERVICE MOBILE PORTAL!

    THIS ELECTRONIC FORM  WAS DESIGNED FOR OUR CLIENTS TO SUBMIT CERTIFICATE OF INSURANCE REQUEST AND THAT WON'T REQUIRED ANY SPECIAL ENDORSEMENT. PLEASE NOTE: REQUESTS THAT WILL REQUIRE ADDTIONAL INSURED FORMS, PLEASE GO TO OUR FULL SITE AT certificate.myatlagency.com.

    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 PERSONAL 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 SPECIFIC COVERAGE, FORMS & POLICY LIMITS LIMITS.

    THANK YOU!
    ATL INSURANCE

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

    • I AM THE POLICY HOLDER AND I'M USING MY SMART MOBILE DEVICE.
    • ALSO 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 INSURED ENDORSEMENT

    ISO Forms

  • IMPORTANT 

    ADDING THIS TYPE OF ENDORSEMENTS WILL RESULT IN ADDTIONAL PREMIUM.

    IF THE ENDORSEMENTS ARE APPROVED BY THE CARRIERS ANY ADDTIONAL PREMIUM MUST BE PAID IN ADVANCE BEFORE BINDING

  • GOT TO OUR FULL SITE PAGE


    Dear Insured,

    Please visit our full page site certificate.myatlagency.com to submit your request adding the certificate holder as an addtional insured.

    Thank you,

    ATL Insurance

     

  •   4. VERIFICATION OF COVERAGE REQUEST

  • Should be Empty: