Church Insurance & Risk Management
Mailing Address:
101 Devant Street
Suite 704
Fayetteville, GA 30214
 
Phone: 770-719-8330
            770-716-0180
 
 
Home      Service      Certificate Request
Please answer each of the questions below, and we'll review your request. If we have everything we need, we'll email the certificate directly to you within one business day.
 
Your Name**:
Ministry Name**:
City**:
Daytime Phone**:
Email**:
Organization Name (Requiring Certificate)**:
Street Address**:
City**:
State**:
Zip**:
Phone Number**:
Fax Number:
Contact's Email**:
Show Certificate Holder as Loss Payee:
Show Certificate Holder as Additional Insured:
Additional Information - Special Wording:
Additional Wording (if necessary):
Describe the Event:
 
(** Required Fields)