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Back to Express Requests

Vacant Land 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
Prior Carrier & Loss Information

Include 3 year loss history

Locations

Include City, State, Zip, No. Acres, and Lake Acreage

Include City, State, Zip, No. Acres, and Lake Acreage

Include City, State, Zip, No. Acres, and Lake Acreage

Include City, State, Zip, No. Acres, and Lake Acreage

Include City, State, Zip, No. Acres, and Lake Acreage

(Business, recreational or other activities)

Such as a condominium, homeowners or business park associations

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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