Elementor #22443 - Elite Anywhere Corp.

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Certificate of Insurance Request

Please use this form to request certificates of insurance (COI). For any questions or issues, please use email address [email protected].

The information requested below is the bare minimum required to process your COI request. Turnaround time to receive COIs is typically 2-3 business days. If you have a sample, please include it with your request (upload within this form below), but this form must still be completed or issuance of the COI could be delayed.

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Your Name

Client Name

Specific Load/Delivery Address Needing COI

Address Line 1

Address Line 2

City

State

Zip Code

Your Email Address

Quote | Proposal #

COI is for

Origin
Destination

Additional insured- Any additional entities needing protection from claims.

Sample COI (File size maximum: 14MB)

Click or drag a file to this area to upload.

Certificate Holder Information

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Certificate Holder Name

NOT the shipper. This is typically specific to the building/facility asking for proof of coverage.

Certificate Holder Phone #

Minimum Coverage Amount (if any)

Certificate Holder Address

Address Line 1

Address Line 2

City

State

Zip Code

Certificate Holder Email Address

Notes/Comments