Strickland General Agency of FL, Inc.                                                                                                   Commercial Garage Certificate Request

Agency Contact:    E-mail Address:    For SGA use only:

Agency #:    Agency Name:

Policy #:    Insured Name:

Certificate Holder's Name:

Mailing Address:

City, State, Zip Code:

1. Attention:

1. Certificate Holder's Fax Number:

1. Special Instructions: