Request a Certificate of Insurance

For more information about coverage, please call us toll-free at: 1-800-526-1379
Standard Processing Takes 2 Business Days

For any teams that have individually registered, please contact your ASA Commissioner for a certificate of insurance. If your team purchased team insurance, please proceed.

If you need rush fax or email service, there is a $25 Rush Processing Fee. Please contact an ASA Customer Service Representative for further details.

Instructions:

Complete the form below to request a certificate of insurance.

Your Information

Please enter your information below.
*Your Name:
*League Name:
*Team Name:
*Address:
Address 2:
*City:
*State:
 
*Zip Code:
*Your Phone:
*Your E-mail:
*E-mail confirmation:

Certificate Holder Information

Please enter the certificate holders information below.
*This certificate should be issued on behalf of (please indicate Team or League name here):
*Does the Certificate Holder need to be named as an Additional Insured?:
Comments or Special Requests:
Certificate Holder Name: (e.g., field owner, facility owner, township, etc)
Certificate Holder Contact Name:
*Certificate Holder Address:
*Certificate Holder City:
*Certificate Holder State:
 
*Certificate Holder Zip:
*Certificate Holder Contact's Phone:
*Certificate Holder Contact's Fax: