Request Certificate

Call (248) 651-7321 8:30 a.m. to 5:00 p.m. EST to speak to a member of our licensed & accredited staff.

 

Please email us at whimsins@whimsinsurance.com or complete the form below:

 

To help us serve you better, please complete all required information (indicated by an asterisk*)

 

Your Personal Information
* Your Name:
* Phone:
Fax:
* Named Insured:
NOTE: If you are the insured person, "your name" should match "name insured".

Method of Delivery
Mail to Insured :
Mail to Certificate Holder:
Fax to Insured :
Fax to Certificate Holder:
Certificate Holder's Information
* Name:
* Street Address:
Apt/Suite Number:
* City:
* State:
      * Zip Code:
Phone:
Fax:
 
Additional Information
Name certificate holder as additional insured?
  Yes
No
Is insured doing job for certificate holder?
  Yes
No
Cost of Job:
Date of Job:
Is additional insured named as landlord?
  Yes
No

Other information:

 


Form Submission Agreement:
I agree that by submitting this form the questions were answered to the best of my ability.
I am authorizing Whims Insurance to act upon the information given. 

Please check if you agree to these terms: 

If you entered a valid email address, you will receive a message on the screen that the form has been sent.  We will personally send you an email confirmation once we have received and evaluated your request.

  

This website designed and maintained by IGD Solutions Corporation.