Commercial Property & Casualty                                                                            Strickland's - Binder Request - (New Business)

You will receive immediate confirmation of binding when you submit this request

Agency #:    Agency Name:    Agency Contact:

E-mail:

New Business Binder Request

 

 

Please                or                         completed and signed application SAME DAY for Binding:

Fax: 678-259-3701

Email:  lacommpc@sgainla.com    

Quote Number:            Line Of Business:

Effective Date:(Must be current date or later)                       Effective Time:

Applicant Name:

Applicant Address:

Applicant City, State, Zip Code:

Business Name:

Limits of Liability:    Property Limits:    Total Premium:

Comments: