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Request A Policy Review


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Church or Organization Contact Information
First Name *
Last Name *
Contact Title
Primary Phone Number *
Alternate Phone Number
Fax #
E-Mail Address *
Best Method of Contact *
Desired Method to Conduct Review *
Property Location
Name of Ministry or Non-Profit *
Street *
City *
State *
ZIP / Postal Code *
Policy Details
Policy Number *
Policy Expiration Date
/ /
To have us review an existing policy, please upload it below.
Upload Policy for Review
Question or Additional Information regarding Policy Review
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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11709 New Hampshire Ave | Bakersfield, CA 93312 | FAX 619-390-8344