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Certificate Request Form

Please allow us 48 hours to process.

Condo/HOA Association Name *
Borrower's Information
Name of Borrower(s) *
Street Address of Unit *
City *
State *
ZIP / Postal Code *
Primary Phone Number *
Lender's Mortgagee Clause (How they would want their name to appear on the certificate) *
Its Successors and/or Assigns, ATIMA
Lender's Mailing Address (required even if being faxed or emailed) *
Loan Number
Fax to
Email to
Closing Date
/ /
Requested By
First Name *
Last Name *
Contact Phone Number *
E-Mail Address *
Submission Validation

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.