Cooper Square

REQUEST AN INSURANCE CERTIFICATE

Thank you for your request for an insurance certificate.

It is our policy to fulfill such requests within 3 business days. In order for us to process your request in this time frame it is important that we have all of the information we need to get a completed certificate to you. If you haven't already done so, please fill out the below Insurance Certificate form. If any question is not applicable, please insert "NA".

Once we have all the information noted in the form, we will process your request as quickly as we can.

Thank you,
Cooper Square Realty, Inc.
Insurance Department

*: required fields
Who is Requesting the Certificate?*
What is the purpose of the certificate?	Select... Refinance Purchase Line of Credit Loan
Your Phone
Your E-Mail*
Where would you like the Certificate e-mailed? *
Additional email addresses you would like Certificate to be e-mailed to
What is your relationship to the Shareholder / Unit Owner?	Self Mortgage Broker Attorney Other
Building Address*
Unit / Apt # (if applicable)*
Shareholder / Unit Owner Name(s)*
Mortgagee*
Mortgagee Address*
Loan Number
What insurance policies must be shown on the insurance certificate? (Check all that apply)*	Property Multi-Peril Flood Insurance General Liability Umbrella Liability Directors & Officers Liability Crime / Fidelity
Mortgagee Clause*
Additional Notes
Enter the text here from the image on the right:*