Select Church Insurance Services

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For customers, please complete the appropriate form below. Please note that submitting a change request does not bind coverage. Incomplete information may cause a delay in processing your request. Upon receipt of your request, we will contact you.

By clicking "Submit", you agree to provide Select Church Insurance Services with the submitted information about you and / or your organization, that you are authorized agent and / or representative of the organization, that you have the authority to submit this request, and that the information provided is accurate.

Ministry Name** Ministry Name is required.Ministry City** Ministry City is required.

Policy Number (Last 6 Numbers)

Date to start coverage

New Location AddressStreet Address** Street Address is required.City** City is required.State** State is required.Zip Code** Zip Code is required.County** County is required.Inside City Limits

Primary Use

Comments

Building InformationMiles to Fire DepartmentDistance to Fire Hydrant

Briefly describe how you use this location including any special activities

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Specials