The following form is provided to you for making changes or requests on your existing policies. By submitting this form you understand that no coverage or premium adjustment of any kind is bound until you receive written notice from us.
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Insurance products are offered through the following insurers: Ontario Insurance Company (Shortsville, NY); Allegany Co-op Insurance (Cuba, NY); Conemaugh Valley (Johnstown, PA); Chautauqua Patrons (Jamestown, NY); The Travelers Indemnity Company (Hartford, CT); Farmers Insurance (Los Angeles, CA); Foremost Insurance (Carol Stream, IL); National General Insurance Company (Winston-Salem, NC); Erie Insurance (Erie, PA); ShelterPoint (Great Neck, NY); Sterling Insurance (Boston, MA); Bristol West Insurance (Independence, OH); and other unaffiliated insurers.
Insurance services are provided by an independent insurance agency. Rouleau Insurance Agency and its producers are licensed in the states where services are offered. License numbers are available upon request. Availability, eligibility, and coverages may vary by state. Not all products are available in all states.
