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Back to Express Requests

Office Express Request

*Complete and submit the form below for an Express Premium Indication from OGA’s Small Business Unit

Fax: 405.840.9388 | 800.771.8116
Phone: 405.840.9393 | 800.299.1951

Agency Information
Applicant Information

Include 3 year loss history

sq. ft.
sq. ft.
sq. ft.
Property Information – Please complete if you would like a Property Quote

Include Address, City, State, and Zip

$
$
sq. ft.
Building Updates

Provide year each item was last updated

Please Note

*Fully completed Acord applications and any applicable supplemental questionnaires are required prior to binding. Please note that the premium indication is subject to change upon receipt of the Acord and any required supplemental.

If needed, please include any comments or additional information here.

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American Association of Managing General Agents Independent Insurance Agents of Oklahoma National Association of Professional Surplus Lines Offices