Certificate Request

Please complete the form below request an insurance certificate.

* Required Fields

POLICY HOLDER INFORMATION
* Full Name		Street Address
		City, State, Zip ,
Home Telephone		Work Telephone
* Email:		Fax
Business Name (if applicable)
RECIPIENT INFORMATION
Recipient's Name		Recipient's Street Address Recipient's City, State, Zip , ,
Recipient's Contact Person
Recipient's Telephone		Recipient's Fax
Recipient's Email
Send via Mail    Fax
CERTIFICATE REQUEST
Is this request for additional insured? Yes    No If yes, please provide details:
Special Instructions
Please choose where the department or contact you want to send to Southeastern Insurance Agency - General Inquiry Email Kathleen Nightlinger -General Manager Edie Nunes - Dartmouth Personal Customer Sales Vickie Lydon - Dartmouth Personal Customer Sales Delta Martins - Personal Customer Service Dartmouth Cecilia “C” Senra Almeida - Personal Customer Service Dartmouth Christine Moreau - Personal Customer Service Dartmouth Sonja Rossitto - Personal Customer Service Dartmouth Germana Farias - Personal Customer Service Dartmouth Lora Lowe - Hyannis Personal Customer Service Helene Murdock - Hyannis Personal Customer Service Randall Mendell - Dartmouth Commercial Sales Scott W. Lowe - Hyannis Commercial Sales Joanne Bretton - Commericial Customer Service Krista Hartford - Commericial Customer Service Karen Bernier - Commericial Customer Service Pauline Desrosiers - Commericial Customer Service Paula Veloso - Claims Jacqueline Carpenter - Accounting
Click the Submit button to send your request:

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Southeastern Insurance Agency, Inc. Website Privacy Policy

Southeastern Insurance Agency, Inc. is committed to providing quality service to meet all the needs of our website visitors. One of the newest and fastest growing delivery channels is the Internet.

A concern arising from the rapidly changing world of technology and specifically the Internet, is your right to maintain privacy. We assure you that we share your concerns and are committed to ensure that all information you supply us is held in strictest confidence.

Visitors to Southeastern Insurance Agency, Inc.'s website will remain anonymous. We do not collect personal identifying information about visitors to our site. If you provide identification (such as name and address) via email or online form, or ask for information, the information provided will only be used to communicate with you to handle your request. It is not sold or transferred to other parties.

Our servers only collect standard non-identifying information about visitors to the site, such as date and time visited, IP address, city, state and country. This information is used to compile standard statistics on site usage.