Location Certificate Request - Aloha Insurance Services

Landlord Name/Business/dba *

Phone

Fax

Email Address

Landlord Address

Address Line 1

Address Line 2

City

State

Zip Code

Is your landlord to be an "Additional Insured" on your policy?

Yes
No

Please Note: Naming your landlord as an additional insured will increase your premium.

Please choose the desired delivery method

Any special instructions for the Aloha Staff

Please Note: Your submitted changes do not take effect immediately. An Aloha Customer Service Representative will review and implement policy changes, and will contact you for additional information if necessary.