King & Cushman, Inc. customers may complete and submit this form to obtain a certificate of insurance.

We will prepare it for the next business day following the receipt of your request and fax, mail or hold it for you to pick up, based on your instructions on this form.

 

Company/Organization requesting proof of your insurance coverage:

Requester's Street:

Requester's City:

Requester's State:

Requester's Zip:

Requester's Fax (if using):

Your Name:

Your Email:

Daytime Phone:

Certificate Delivery Instructions:

Other Comments/Requests:

Thank you, you will receive an email confirmation as soon as we receive this form.