How can we help you?

Are you a current client of our agency?*
- Yes
- No
What policy number(s) do you need help with if available?
What is the nature of your inquiry?*
- General Question
- ID Card Request
- Policy Change Request
- Discuss A Claim
- Certificate of Insurance
Describe your policy change request
What date do you need this policy change/request to take effect?*
DD slash MM slash YYYY
Which vehicle do you need an ID card for (please enter year, make, and model)?
Year Make Model
Your Name*
First Last
Your Email*
Your Phone*
Please list the Additional Insured and/or Certificate Holder
Additional 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:*
Consent*
I agreeI consent to receiving SMS and/or Email communications relating to this request.to the privacy policy.
By submitting this form, you consent to receive SMS messages and/or emails from our company. To unsubscribe, follow the instructions provided in our communications. Msg & data rates may apply for SMS. Your information is secure and will not be sold to third parties.
Name
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Specialized Insurance Group

301 S Main Street
Suite 195
Salisbury, North Carolina 28144

(704) 209-1656

Request Your Proposal Here

Are you ready to save time, aggravation, and money? The team at Specialized Insurance Group is here and ready to make the process as painless as possible. We look forward to meeting you!

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Year	Make	Model

How can we help you?

Would You Like Us To Review Your Policies?

Request Your Proposal Here