Bradenton, Florida Office July 23, 2019 Contact & Customer Service Form Are you a current client of our agency?*YesNoWhat policy number(s) do you need help with if available? What is the nature of your inquiry?*General QuestionID Card RequestPolicy Change RequestDiscuss A ClaimCertificate of InsuranceDescribe your policy change requestWhat date do you need this policy change/request to take effect?* Date Format: DD slash MM slash YYYY Which vehicle do you need an ID card for (please enter year, make, and model)?YearMakeModel Your Name* First Last Your Email* Your Phone*Please list the Additional Insured and/or Certificate HolderAdditional Insured and/or Certificate Holder Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Details regarding your question, policy change, claim or other request:*CAPTCHA Toll Free: (800)-424-3782 Fax: (941) 753-9472 7347 52nd Place E. Bradenton, FL 34203 Get directions (941) 755-9500 info@horizonins.net
