Use this form to add an Additional Insured / Request a Certificate of Insurance, make changes to your Policy, or request a Callback. How can we help? Do you have a policy already? Yes No I would like assistance with * adding an Additional Insured to my policy making changes to my policy renewing my policy filing a claim something else I would like assistance with * getting a Quote purchasing a Policy something else Okay. No problem. Which specialty insurance policy? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Right! Great Choice. Did you know you can add an Additional Insured and get an instant Certificate of Insurance using our online policy management system? Would you like to use this form anyway or sign in? * Use this form Sign in and Manage Your Policy Okay. Request for certificates using this form are processed during business hours on a first come, first served basis. Here we go. What is the name of the person on the policy? * What is your name? * Are you a broker? * Yes No What is your telephone number? * What is your email address? * Would you prefer we email you or call you? * Call Me Email is better Whatever you need Okay, if we have questions we'll contact you by email. What is the best time to call? * Mornings Afternoons Hidden Flag - Show more js We just need a few more details. What is your Client ID, Policy or Memorandum number? * What type of Event is this? * Which Drone is the Additional Insured for? * Hidden Flag - Detect mobile js Hidden Flag for Extra Time Fields Hidden Flag for Extra Services Provided DJ Hidden Flag for Field Position What Event What day does your event start? * What time does your event start? * Event Start Time 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM What day does your event end? * What time does your event end? * Event End Time 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM What day and time does your event start? Start Date (Desktop) * Start Time (Desktop) * Event Start Time 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM What day and time does your event end? Stop Date (Desktop) * Stop Time (Desktop) * Event Stop Time 12:00 AM 12:30 AM 1:00 AM 1:30 AM 2:00 AM 2:30 AM 3:00 AM 3:30 AM 4:00 AM 4:30 AM 5:00 AM 5:30 AM 6:00 AM 6:30 AM 7:00 AM 7:30 AM 8:00 AM 8:30 AM 9:00 AM 9:30 AM 10:00 AM 10:30 AM 11:00 AM 11:30 AM 12:00 PM 12:30 PM 1:00 PM 1:30 PM 2:00 PM 2:30 PM 3:00 PM 3:30 PM 4:00 PM 4:30 PM 5:00 PM 5:30 PM 6:00 PM 6:30 PM 7:00 PM 7:30 PM 8:00 PM 8:30 PM 9:00 PM 9:30 PM 10:00 PM 10:30 PM 11:00 PM 11:30 PM What type of Event is this? * What services will you provide for this event? * What type of Additional Insured is this? * What is the name and address of the Additional Insured? * Street * Address 2 City * State * -- Select State -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Any Additional Insured wording you’d like to add? This is optional. Would you like a copy of the Certificate sent to another email address, such as to your Additional Insured? What is the email address to send a copy? Is there anything else you'd like to add? This is optional. Okay. No problem. Which specialty insurance policy? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Great choice! We just need a few more details to assist you. What is the name of the person on the policy? * What is your name? * Are you a broker? * Yes No What is your telephone number? * What's the best time to call? * Mornings Afternoons What is your email address? * What is your Client ID, Policy or Memorandum number? * What changes would you like to request on your policy? * Okay. No problem. Which specialty insurance policy? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Great choice! We just need a few more details to assist you. What is your name? * What is the name of the person on the policy? * Are you a broker? * Yes No What is your telephone number? * What’s the best time to call? * Mornings Afternoons What is your email address? * What is your Client ID, Policy or Memorandum number? * Comments? (Optional) Okay. No problem. Which specialty insurance do you have? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Ok, we just need a little bit more information before one of our insurance experts can assist you. What is your name? * Are you a broker? * Yes No NOT NEEDED - What is the name of the person on the policy? (i.e. named insured) What is your telephone number? * What's the best time to call? * Mornings Afternoons What is your email address? * What is your Client ID, Policy or Memorandum number? * Anything you'd like to add? Okay! No problem. Which specialty insurance? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Right! Great choice. Hidden Flag - Show more js Would you like one of our insurance experts to call you? * Yes No Great, thank you. What is the best time to reach you? * Mornings Afternoons Sounds good. We just need a few more details. No problem. We'll email you. We just need a few more details. What is your name? * Are you a broker? * Yes No What is your telephone number? * What is your email address? * What is your email address? (This is optional) What is your Client ID, Policy or Memorandum number? * NOT NEEDED - What is the name of the person on the policy? (i.e. named insured) How can we help? Okay! No problem. Which specialty insurance? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Right! Great choice. Did you know you can get an instant online quote on our website? Would you like to get an Instant Online Quote or continue with this form? Continue Get an Instant Online Quote Hidden Flag - Show more js Would you like one of our insurance experts to call you? * Yes No Great! What is the best time to reach you? * Mornings Afternoons Sounds good. We just need a few more details to assist you. No problem. We'll email you. We just need a few more details. What is your name? * Are you a broker? * Yes No What is your telephone number? * What is your email address? * What is your email address? (This is optional) How can we help? Okay! No problem. Which specialty insurance? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Right! Great choice. Did you know you can get an instant online quote on our website? Would you like to get an online quote now or continue with this form? Continue Get an Instant Online Quote Hidden Flag - Show more js Would you like one of our insurance experts to call you? * Yes No Great, thank you. What is the best time to reach you? * Mornings Afternoons Sounds good. We just need a few more details to assist you. No problem. We'll email you. We just need a few more details. What is your name? * Are you a broker? * Yes No What is your telephone number? * What is your email address? * What is your email address? (This is optional) How can we help? Okay! No problem. Which specialty insurance? * PTA Insurance PTO Insurance Booster Club Insurance Parent Group Insurance Nonprofit Chapter Insurance Other Insurance Right! Great choice. Hidden Flag - Show more js Would you like one of our insurance experts to call you? Yes No Great! What’s the best time to call? Mornings Afternoons Perfect. We just need a few more details. No problem. We'll email you. What is your name? * Are you a broker? * Yes No What is your phone number? * What is your email address? * What is your email address? (Optional) * Anything you’d like to add? If you are human, leave this field blank. Submit