Property Insurance Clarity Act

Company Registration

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To register please complete the following information.  All fields are required.

After company has been registered, user can then file for an exemption.

Please select your company from the company drop-down list below.  If your company's name is not in the list, please call us at (334) 241-4115.

Company Name:


NAIC #:


Contact's First Name:


Contact's Last Name:


Contact's Phone Number:
 

Ext:


Contact's Email Address:


Confirm Email Address:


Contact's Mailing Address:


Address (Line 2):


City:


State:


Zip Code:


Password:


Confirm Password:

Note: Password must be 6-12 characters



For additional security, please check the checkbox below (and complete any puzzle prompts you may receive).