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Insurance Certificate Request

If your building management requires a certificate of insurance to be provided, please fill in the parties to be insured as well as their address.

Installation date

* Date: Show calendar

Customer Information

* Name:
* Address:
* Phone:
* E-mail:

Management Information

* Contact Name:
* Phone:
* Fax:
General info:

The certificate should read

Job location:
Additional
insureds:
Certificate
holder:

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Phone: (718) 366 - 0665
Fax: (718) 366 - 0133

e-mail: info@RoomDividersNY.com

 

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