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New Personal Membership Request -

Personal Information

* First Name What's This?
* Last Name
Company
* Address
* City
* State
* Zip Code
* Phone
nnn-nnn-nnnn
Mobile Phone
nnn-nnn-nnnn
Fax
nnn-nnn-nnnn
* Email
yourname@yourdomain.com
* Password

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* denotes required information

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Create an account to:

  • File Claims
  • Make Policy Changes
  • Request Auto ID Cards
  • Make Payments
  • Request Certificates

QUICK LINKS

– Claims
– Quotes
– Change Requests
– Make a Payment
– Request a certificate
– Request ID

BUSINESS HOURS

Monday-Friday: 8:00am to 5:00pm
Saturday: 9:00am to 12:00pm
Sunday: Closed

CONTACT

823 N. Section Street
PO Box 406 Sullivan, IN 47882

800-489-4711 (toll free)
812-268-4711 (local)
812-268-3809 (fax)

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