requests

         
By filling in the information below - we will be able to process your request for a certificate of insurance. If you should have any questions regarding the completion of the form - you may call 513.868.9000 or email kathy@wilksinsurance.com. Your requested will be submitted and processed within 2 business days. You will be notified when the request has been completed.
         
  Insured Name:  
         
  Division:  
         
  Job Description or Contract Number:  
         
  Certificate Holder:  
     
         
  Enter the mailing address where we are to send the Certificate:  
   
   
         
  Faxing/Mailing Instructions:  
         
  Do you need to listed as LOSS PAYEE?   Yes  No  
         
  Do you need to be listed as ADDITIONAL INSURED?   Yes  No  
         
  Do you need to be listed as MORTGAGEE?   Yes  No  
         
  Any special wording?  
         
  Your Email Address:    
         
  Where can we call you:    
         
  Phone    
         
   
         
 

 
Google Plus Mason Facebook Google Plus Mason

As an independent insurance agency Wilks Insurance Agency have provided Greater Cincinnati residents with the best home and car insurance protection available.

319 N 2nd St Hamilton OH 45011 USA (513) 868-9000