Forms & Applications
For your convenience you can complete and submit our forms online if using Internet Explorer or download applications with Adobe Acrobat Reader® and send to:
Quote Requests: apps@abraminterstate.com
Bind Requests: binds@abraminterstate.com
Service Requests: service@abraminterstate.com
Lloyds of London 1st Report of Loss Click Here
As an option, you may fax a completed form to 916.780.7181
Accounting
- Check by Fax Form (Customer Payment)
- Agency Sweep Authorization
Equine Mortality
- Hassle Free Mortality Application
- Standard Mortality Application
- Markel Justification of Value – Please complete this form when required.
Farm / Ranch
- ACORD 401 – Agriculture Application
- ACORD 402 – Agriculture Property Section
- ACORD 403 – Agriculture Property Section – Scheduled and Unscheduled Farm Personal Property
- ACORD 404 – Agriculture Liability Section
- Travelers Farm/Ranch – Please complete this form for property and liability coverage for working horse, cattle and crop farms.
- Travelers Equine Liability Application – Please complete this application for any risk with owned or non-owned horses.
- Travelers CCC – Optional endorsement when there are non-owned horses.
- Great American Equine Farm – Complete this application for property & liability for horse farms.
- Great American Equine Liability Application – [editable, Adobe] – Complete this application for commercial equine liability coverage. If the applicant owns the property, please complete the Great American Equine Farm application (above.)
- Great American CCC – [editable, Adobe] – Coverage is only applicable for non-owned horses. Please complete this form in addition to the Equine Farm or Equine Liability application if coverage is desired.
- Great American Individual Horse Owner Liability – Coverage for personal horses only. No commercial operations can be present.
- Great American Race Horse Owners Liability – Coverage for horses used for racing or race training
- Markel Commercial Equine Application
- Markel Private Horse Owner – Please complete this application if there are no commercial operations. Additional Insureds are not permitted on this policy.
Commercial Lines
Commercial Property and Casualty Quick Quote – Indication ONLY
ACORD Forms
- ACORD 125 & ACORD 126 – General Libaility
- ACORD 125 & ACORD 140– Property
- ACORD 125, ACORD 126, & ACORD 140 – Package Policies
- ACORD 125 – Commercial Insurance Application
- ACORD 126 – General Liability
- ACORD 130 – Workers’ Compensation
- Workers Compensation Supplemental Application
- ACORD 131 – Commercial Umbrella
- ACORD 140 – Property
- ACORD 146 – Equipment Floater
- Employment Practices Liability Application
Commercial Auto ACORD Applications
Other Forms
- ACORD 36 – Broker of Record
- ACORD 37 – Statement of no loss
- ACORD 25 – Certificate of Liability Insurance
- ACORD 28 – Evidence of Commercial Property Insurance
- Special Event Liability Application – The Main Event
- Contractors Supplemental Questionnaire
- ** Forms Required to Bind Non-Admitted Risks **
- Medical Risks Supplemental Forms for Allied Health:
Personal Lines
- ACORD 80 – Homeowner Application – YouTube Howto Video
- ACORD 84 – Dwelling Fire Application – YouTube Howto Video
- ACORD 1 – Property Loss Notice
- ACORD 67 CA – Residential Property Insurance Disclosure
- ACORD 70 – Personal Policy Change Request (Except Auto)
- ACORD 66 CA – Offer of Earthquake
- ACORD 81 – Personal Inland Marine
- ACORD 83 – Personal Umbrella Application
- Woodstove Supplement
- High PC
- Log Home Questionnaire
- FSC User Guide
AU Gold
- AU Gold COC Application
- AU Gold Dwelling Fire Application
- AU Gold Renovation Application
- AU Gold Vacant Application
- AU Gold Vacant Land Application
Chubb
Lloyds of London
- Binding Instructions: Fax or Email your request to bind with the following:
- Signed ACORD 80 – Homeowner Application
- Signed ACORD 84 – Dwelling Fire Application
- D-1 Form
- Send money to Abram Interstate within 7 days
- LLC Trust Corporate Supplement
- ACORD 85 – Mobile Home Application
- Lloyds Homeowner Guidelines
- Lloyds Dwelling Fire Guidelines
- Lloyds 1st Report of Loss
Safeco
- Use Acord Forms
- Safeco Home & Dwelling Fire Underwriting Guidelines
Travelers
- Binding Instructions: Fax or Email your request to bind with the following:
- Signed ACORD 80 – Homeowner Application or Signed ACORD 84 – Dwelling Fire Application
- For Dwelling policies send a copy of the declarations page of the rental insurance and a copy of the lease agreement.
- Send money directly to Travelers:
Travelers Remittance Center
One Tower Square
Hartford, CT 06183-9003
TOPA
- Binding Instructions: Fax or Email your request to bind with the following:
- Send money to Abram Interstate within 7 days
- If FSC quote, submit signed FSC quote.
- TOPA Homeowners Application
- TOPA Dwelling Fire Application
- TOPA ACORD Supplemental Application
- TOPA Replacement Cost and Earthquake Disclosures
- TOPA Water Disclosure Form
- TOPA Home Business Supplemental Form
- TOPA Race Gender Form
- TOPA Homeowners Guidelines
- TOPA Dwelling Fire Guidelines
Auto
TRAVELERS- Preferred
- Binding Instructions: Once approval from Account Manager received, Fax or Email your request to bind with the following:
- ACORD 90 CA – Personal Auto Application (signed by Named Insured and Agent)
- Any additional supplemental forms to support discounts or rating – UM waiver, driver exclusions, proof of discounts
- Premium for down payment or full premium by either agency sweep, customers check or customers credit card
- EFT requires completed & signed EFT authorization form with voided check
- Quoting Instructions: Fax ACORD Personal Auto Application to 916.780.7181 or Email application to apps@abraminterstate.com If obtained, include:
- FSC quote (if applicable)
- MVR’s
- CLUE Reports
- Proof of discounts being offered
- Please note: An accurate rate requires VIN and Driver License numbers
- ACORD 90 CA – California Personal Auto Application
- ACORD CA Auto Supplement (Uninsured Motorist Reduction/Waiver)
- Travelers Named Driver Exclusion
- Good Student/Driver Training (ACORD 91)
- Travelers EFT Enrollment Form
- ACORD Personal Auto Policy Change Request
- Travelers Auto Guidelines
- Privacy Policy Notice
Kemper Specialty – Non-Standard Programs
- Quoting Instructions: Fax ACORD Personal Auto Policy Change Request to 916.780.7181 or Email application to apps@abraminterstate.com If obtained, include:
- FSC quote (if applicable)
- MVR’s
- CLUE Reports
- Proof of discounts being offered
- Please note: An accurate rate requires VIN and Driver License numbers Quote & Bind directly with this carrier! Click on the link below to complete an application for direct access through Abram Interstate
- Kemper Specialty – Broker of Record
- Uninsured Motorist Rejection/Reduction Form
- Named Driver Exclusion
- Credit Card Authorization Form
- Automatic Withdrawal/EFT Authorization
- FIC-Unitrin Auto Guidelines
SAFECO- Preferred & Standard Programs
Binding Instructions:
- Fax or email the Safeco application provided at the time of quote request signed by both named insured and agent with request to bind.
- Include any supplemental paperwork requested with your quote approval from Abram.
- Visit our “forms” section on abraminterstate.com for supplemental forms.
- Down payment by customer credit card, customer’s check, or agency trust check.
Quoting Instructions: Please note: An accurate rate requires VIN and Driver License numbers
- Fax ACORD 90 CA – Personal Auto Application to 916.780.7181 or
- Email application to apps@abraminterstate.com
- If obtained, include:
- FSC quote (if applicable)
- MVR’s
- CLUE Reports
- Proof of discounts being offered
- ACORD 90 CA – California Personal Auto Application
- Safeco Uninsured Motorist Rejection/Reduction Form
- Safeco Driver Exclusion
- ACORD Good Student/Driver Training
- ACORD Personal Auto Policy Change Request
- Safeco Auto Guidelines
- Safeco Automatic Deduction Authorization
Commerce West Insurance – Preferred Auto, Non-standard, and Nation Safe Driver Programs
Binding Instructions:
- Fax or email Commerce West Application (signed by both named insured and producer) with request to bind.
- Include any supplemental paperwork requested with your quote approval from Abram.
- Down payment by agency trust check.
Quoting Instructions: Please note: An accurate rate requires VIN and Driver License numbers Quote & Bind directly with this carrier! Click on the link below to complete an application for direct access through Abram Interstate:
- Fax ACORD 90 CA – Personal Auto Application to 916.780.7181 or
- Email application to apps@abraminterstate.com
- If obtained, include:
- FSC quote (if applicable)
- MVR’s
- CLUE Reports
- Proof of discounts being offered
- Uninsured Motorist Rejection/Reduction Form
- Named Driver Exclusion
- Business Use Exclusion
- EFT Authorization Form
