5220 West Michigan Avenue
Kalamazoo, Michigan 49006
Phone: (269) 372-1100
Fax: (269) 372-6880
E-MAIL US

We represent...
YOU.

We bring you the
products and services...
YOU ASK FOR.

Under the conditions...
YOU WANT.

We add tracking, training
and support to everything
we sell and our staff is
properly trained and
motivated...
TO SATISFY
YOUR NEEDS.

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Finance & Insurance Division

FORMS

Most of our insurance forms are now available online. Click any of the documents below to view that form in PDF format.

• ACDelco Cancellation Form (154k)
• ACDelco Remit Sheet (151k)
• Agricultural GAP Cancel Form (93k)
• Agricultural GAP Insurance Claim Form (982k)
• Allstate First Colonial Gap Remit Sheet (74k)
• Allstate First Colonial Gap Cancellation Form (100k)
• Allstate First Colonial Gap Claim Form (77k)
• American General Death Claim Form (728k)
• American General Disability Claim Form (888k)
• American Heritage Disability Claim Form (38k)
• American Heritage Death Claim Form (32k)
• American Heritage Remit Sheet (119k)
• Arch Gap Remit Sheet (74k)
• Arch Gap Cancellation Form (96k)
• Arch Gap Claim Form (77k)
• AutoGuard Remit Sheet (29k)
• Auto Perfect Cancellation Form (25k)
• AutoPerfect Remit Sheet (84k)
• Call In Log (111k)
• Cancellation Quote Directory (234k)
• Cancellation Ticket (115k)
• Cardif (FAMLI) Remit Sheet
. Cardif (FAMLI) Disability Claim Form
. Cardif (FAMLI) Life Benefit Claim Form
• Central States Of Omaha Remit Sheet (84k)
• Central States of Omaha Disability Claim Form (127k)
• Central States of Omaha Death Claim Form (130k)
• Classic GAP Remit Sheet (245k)
• Debt Cancellation Remit Sheet (66k)
• Guarantee Price Refund (GPR) Remit Sheet (18k)
• Guarantee Trust Death Claim Form (184k)
• Guarantee Trust Disability Claim Form (1021k)
• Guarantee Trust Remit Sheet (107k)
• Hartford GAP Cancel Form (93k)
• Hartford GAP Claim Form (982k)
• IAS Remit Sheet: T&W/PDR/ETCH (211k)
• Intire Tire & Wheel Cancellation Form (459k)
Interstate Remit Sheet
• Investors Heritage Death Claim Form (140k)
• Investors Heritage Disability Claim Form (972k)
• Investors Heritage Remit Sheet (51k)
• Life Investors Death Claim Form (253k)
• Life Investors Disability Claim Form (996k)
• Life Investors Remit Sheet (716k)
• Madison National Disability & Death Claim Form (688k)
• Madison National Remit Sheet (573k)
• Millennium Cancellation Form (113k)
• Millennium Remit Sheet (173k)
• Millennium Transfer Form (109k)
• Nation Safe Cancellation Form
• Nation Safe Drivers Remit Sheet (61k)
• Lyndon Property Protective Gap Cancellation Form (216k)
• Lyndon Property Protective Gap Claim Form (498k)
• Lyndon Property Protective Remit Sheet (230k)
• Old Republic Gap Remit Sheet (235k)
• Remittance Address Directory (172k)
• Safeguard/Safelease Remit Sheet (42k)
• Stonebridge Gap Cancellation Form (182k)
• Stonebridge Gap Claim Form (616k)
• Stonebridge Gap Remit Sheet (157k)
• Universal Warranty Cancellation Form (148k)
• Vehicle One Cancellation Form (128k)
• Vehicle One Remit Sheet (156k)
Vehicle One Transfer Form
Vehicle One Primary Claim Form
Vehicle One Primary Gap Remit Sheet
Vehicle One Primary Gap Cancellation Form