Certificate of good standing - Fairway Underwriters
FAIRWAY UNDERWRITERS
Request for Certificate of Insurance
All Certificates of Insurance will be sent directly to your email address,
unless specified otherwise below.
(Use a separate request for each certificate holder)
Complete and email to karen@ or fax to 978 454-8740
Name of Your Business ____________________________________________________________
Mailing Address: __________________________________________________________________
City, State, Zip: ___________________________________________________________________
Phone Number: _______________Cell: _______________ Email: __________________________
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Certificate Holder: ___________________________________________________________
___________________________________________________________
___________________________________________________________
Street Address
___________________________________________________________
City State Zip Code
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_____ Please fax or email a copy of our Certificate of Insurance directly to the Certificate Holder.
Certificate Holder’s Fax #: _____________________________________________
Certificate Holder’s email: _____________________________________________
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SPECIAL INSTRUCTIONS
__________________________________________________________________________
__________________________________________________________________________
__________________________________ _______________________
Signature of Insured Date
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