Request Certificate2017-12-21T00:51:36+00:00

Certificate of Insurance Request

You are welcome to request a certificate of insurance via our online form below.  However, please note that requests received via our website do not constitute a binder of coverage nor has coverage been amended until you have spoken with a BenTec Insurance team member.  If you are making this request as a third-party, please know that we will need to confirm authorization with our client before providing confirmation of coverage.

Our agency team may be reached at 580.256.9918.

Your Name (required)

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Subject

Certificate Holder

Address Line 1

Address Line 2

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Fax

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Policyholder/Named Insured

Individual Requesting Certificate

Please reference any Additional Insureds, Job Descriptions, or Waiver of Subrogations below along with any additional information you would like to list.

Call Us Anytime: 580-256-9918
We Are Always Here To Help And To Answer Any Of Your Questions!