Questions? Call (727) 578-4400

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for use as a Check-List.

Change of Name Form

General Notes:

  • For questions requiring additional explanations  - Select Application Attachments from the menu on the left
  • Use the Check List provided
  • Call our office (727.578.4400) if you have any questions

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When you are ready to fill out the application click here or on the button below.

 

Change of Name Checklist

  1. Sign your official signature as currently commissioned.

  2. Sign your new official signature the same, as your new commission name.

  3. Imprint your current seal in the space provided.

  4. Locate your current, original Certificate of Commission.

  5. Mail the completed form and a check in the amount of $40.00 (includes tax) made payable to:

North American Insurance Services
14100 US Highway 19 North
Suite 105
Clearwater, FL 33764-7203

 

North American Insurance Services, Inc.
14100 US Highway 19 North  Suite 105

Clearwater, Florida 33764-7203

727.578.4400 Office

727.577.4991 Fax

For information information@suretyware.com