Fitness and Wellness Insurance
Request Certificate
  Account or Policy Number  
Type of request
  Proof of coverage   Additional Insured   Loss payee/mortgagee   Special event
Your Contact Information
First Name  Last Name 
Address  City State Zip 
Home Phone  Fax 
Additional Insured
Eligible Additional Insured types include landlords, property managers, equipment rental companies, mortgagees and lien holders. Click LINK for full explanation of terms. If you have a different type of entity or require special certificate wording, please contact customer service. If you are hosting a special event, tournament, retreat, or any other type of off-site event that fits these specifications, you must contact Customer Service for further review of your event at 877.438.7459. Otherwise your event is automatically covered under your current policy
Please explain the Additional Insured’s Interest in your operations

If you have any website related questions regarding this form, please email the

If you have any insurance related questions regarding this form, please email