Supplemental Applications

Forms

Looking for a form? All of our forms are available for download and can be filled out on your device.

Basic

Authorization for ACH Direct Debits

Credit Card Payment Authorization

Credit/Debit Card Payment by Phone

Email Delivery Approval Form for OfficeScope

Midrox Restaurant Questionnaire

Midrox Landlord Package Application

Midrox Supplemental Residence Application

Optional Basic Economic Loss (OBEL) Coverage

Supplementary Uninsured/Underinsured Motorists Insurance

Part C – Affidavit by Producing Broker

Acknowledgement of Requirement for Photo Inspection

Safeco Supplemental Auto Quote Sheet

Lancer

Commercial Automobile Application

Dealer & Transporter Plate Application

Garage Liability Application

Hired Car Application

Non-Ownership Application

Lancer Non-Ownership Application

Utica First

Antiques and Collectibles Supplement

Automobile Service or Repair Station Supplemental

Convenience Store Supplemental

Apartment Supplemental

Liquor Liability Application

Food Service/Restaurant and Tavern Application

Mandatory Artisan Contractors Supplemental Application

Exclusion of Injury to Employees, Contractors, and Employees of Contractors

Exclusion – Commercial Spray Painting

Roofing Operation Specification Exclusion Endorsement

Buy Back Exclusion Endorsement – Snow Removal Operations

Exclusion – Snow Removal Operations

Notice of Terrorism Insurance Coverage – CT/PA/OH

Notice of Terrorism Insurance Coverage – NY/NJ

Exclusion of Injury to Employees, Contractors, and Employees of Contractors – NY