Insurance Policy Service Request Form from RIS Direct!

"California, Hawaii, Arizona, Nevada, New York, New Jersey, Florida, and Colorado Insurance Specialists!"

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Customers Are Saying!

Click Link above to get a FREE
and FAST California auto quote.
We represent several carriers
and we can save you money!

Click Link above to obtain a
California homeowners quote.
We can help you with your
escrow closing, and we can
issue policies the SAME DAY!

Protect your valuable assets
with a personal umbrella policy.
Click Link above for your quote.
$1 Million coverage starts as
low as $185.00 per year!

    Service to Your Account
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    Customer Testimonials
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10 Reasons Why You Should Use The Services of RIS Direct!

1. We offer a complete "Satisfaction Guarantee" to every customer!

2. The best coverage at the lowest price.

3. Instant phone quotes for most products.

4. Convenient payment option offered on most policies.

5. Internet quotes returned within 24 business hours.

6. We have the complete personal insurance solution offering auto, home, and umbrella protection on every account.

7. Rates are shopped exclusively for you based on your unique insurance need.

8. Huge discounts on ALL insurance products!

9. Our experience allows us to match you with the program(s) best meets your needs.

10. We have been saving our customers money on insurance since 1994.

"Service My Insurance" Account Request Form One Simple Form - takes only 2-3 Minutes! Your Personal Data
Your Name
Street Address:
City:
State:
Zip/Postal:
E-Mail (REQUIRED):
Phone (REQUIRED):
Fax: (Optional)

Policy & Service Details
Your Policy Number:


What do You Need?	Policy change Insurance Certificate Claim Assistance Other


Describe Your Service Need in DETAIL: (If you need a certificate of insurance, list name and complete address of certificateholder here.)

Please contact me for service via:	Fax E-Mail Regular Mail Please Call Me!

Thank you for filling out this form COMPLETELY!
We deem your data submitted as PRIVATE information. Every step has been taken to insure your privacy, security, and to release this information only to you. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Also, the insurance carriers reserve the right to issue coverage or not, and we cannot guarantee acceptance of a risk until approved by the company.
Yes, Please Service My Account. I Understand that NO COVERAGE IS BOUND on insurance changes until confirmed IN WRITING BY OUR AGENCY.

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