Eugene Wilson & Co. LLC Insurance Agency of Bardstown, KY

Insurance Resources for Kentucky Business Owners & Residents
"Find Out Why We Have Been Central Kentucky's
Insurance Sales & Service Leader for over 100 years!"

Visit Our Agency's
Valuable Kentucky
Insurance Resources:

  Home Insurance Quotes
  Auto Insurance Quotes
  Personal Umbrella Quotes
  Watercraft Quotes
  Renter's Ins. Quotes

  Request Certificate
  Business Owners Quotes
  Workers' Compensation
  Contractor Quotes
  Surety & Fidelity Bonds
  Group Health Quotes

  Life Insurance Quotes
  Health Insurance Quotes
  Disability Income Quotes
  Long Term Care Quotes

  Free Financial Profiles
    & Estate Planning
  Pension Plans
  Business Continuation Plans
  Buy-Sell Planning
  Payroll Deduction Plans

  Service My Account
  Request Certificate
  Report a Claim
  Our Agency
  Our Customers Say it Best
  Map to Bardstown Office
  Map to Louisville/Metro Office

Questions?
Please Contact
Us Today!

You May
E-mail
Us At:

ewco@ewco-ins.com

Phone: 1-502-348-5921
Fax: 1-502-331-0023
Toll Free: 1-800-999-5921

602 Bloomfield Road
Bardstown, KY 40004

KY Insurance License #:
611145

"All Our Policies Come With an Agent!"

"Request Insurance Certificate" Online Order Form One Simple Form - takes only 2-3 Minutes! Your Personal Data
Your Name
Street Address:
City:
State: (Must be Kentucky)
Zip/Postal:
E-Mail (REQUIRED):
Phone (REQUIRED):
Fax: (Optional)

Certificate Request Details (You Must Complete ALL Information Below)
Your Policy Number:

Location of Job/Project:

Detailed Description of Job/Project:

Which do you need?	Certificate of Insurance ONLY -or- Certificate of Insurance WITH Additional Insured Endorsement

Additional Wording Required? (If so, list here):


Name and Address of Certificate holder/additional insured :

Coverage Requested:	General Liability Workers Comp/DBL Auto Other

Delivery Instructions: (If Faxing, fill in fax info in following question)	Mail to Certificate Holder Fax to Certificate Holder Fax to My Office Someone Will Pick Up ASAP Mail to My Office

Fax Number Where Certificate Should be Faxed To:

What is this party's insurable interest to you as named insured (i.e., landlord, permit, for job, etc.)

What is the Additional Insured's relationship to job being performed? (i.e. Owner, managing agent, lessor, general contractor, etc.)

Thank you for filling out this form COMPLETELY!
We deem your data submitted as PRIVATE information. Every step has been taken to insure your privacy, security, and to release this information only to you. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Also, the insurance carriers reserve the right to issue coverage or not, and we cannot guarantee acceptance of a risk until approved by the company.
NOTE: IF THERE IS A CHARGE FOR YOUR CERTIFICATE, WE WILL BILL YOU FOR THIS CERTIFICATE.
Yes, Please Service My Account. I Understand that NO COVERAGE IS BOUND on insurance changes until confirmed IN WRITING BY OUR AGENCY, and agree to pay the charge for this certificate, if any.

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