800 - 774 - 5147

Certificate Request

Please complete the information below for your certificate. Include as much information as possible.

Coveryou.com's policy for issuing a certificate is a 24 hour turnaround. With the recent change in additional insured requests from the State of Georgia, it will take us this long. If an additional insured endorsement is required, this may take up to 2 weeks for the carrier to process and make available to us (depending on the carrier). We are sorry for any inconvenience, this is beyond of our control. Thank you.

What is the name of your Company: *
Your Address Street:
Your City:
Your Zip Code:	(5 digits)
State:
Daytime Phone:
What is the name of the Company / Person that is requesting your Certificate: *
Address:
Address 2:
City:
State: *
Zip Code:
Fax Number:
Email:
	Additional Insured *
Addtional Information
	*An Additional Insured may result in a additional premium. Please contact us if you have any questions on what language we are allowed to put on the certificate for the State of Georgia.