Contact us

845.353.4940

Send us an email!

Scott Eidman (President): scott@eidmanagency.com

Norma Eidman (Director): norma@eidmanagency.com

Danielle (Commercial Lines): danielle@eidmanagency.com

Gail Eidman (Financial Lines): gail@eidmanagency.com

Zachary Eidman (Personal Lines): zach@eidmanagency.com

Betsy Eidman (Commercial lines): elizabeth@eidmanagency.com

Kelsey (Personal lines): kelsey@eidmanagency.com

Fax

Personal Lines FAX: 845.358.8205

Commercial Line FAX: 845.353.0305

Emergency Number 845.323.9219

Eidman Agency Inc. 145 Route 303 South West Nyack, NY 10994

Insurance Agency

Certificate Request Form


Certificate Request:

Please fill-in as much as possible. The more information, the more accurate the quote.
All information provided will be kept totally confidential and will not be shared with any other agency or organization.

*Name:

*Company:

*Email:

*Address:

*Phone / Fax::

Select Certificates needed::

*Certificate Holder Name:

*Certificate HolderAddress:

*Certificate Holder City:

*Certificate Holder State:

*Certificate Holder Zipcode:

*Job Site / Project Location:

*Certificate Holder Fax/Email:

Certificate Holder Attn:

Add Certificate Holder as Additional
Insured: (Additional cost may apply):

Remarks:�

Company informations

Insurance Agency
Eidman Agency, Inc.

145 Route 303 South
West Nyack, NY 10994

Contact details

E-mail address:
info@eidmanagency.com

Call us:

Phone: 845.353.4940

Toll Free: 888.655.5253

Fax: 845.358.8205