Florence Office: 256-718-0953


Lexington Office: 256-229-6624

The Certificate of Insurance Request Form is intended for Sam Newton Insurance Commercial Insurance Customers.

Please complete the Request Form with as much detail as possible. Should your Certificate of Insurance require specific language, please fax or email the Certificate Holder’s example Certificate to our office. Once your request has been processed, you will receive a confirmation email from Sam Newton Insurance. If you have not received a confirmation email within 24 hours, please contact our office immediately.

Certificate of Insurance Request

Contact Person(Required)
Contact Person
Additional insured?
Waiver of Subrogation
Max. file size: 60 MB.