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

Quotes


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.

Homeowners FormAutomobile/Motorcycle FormCertificate Request Form

Homeowners Form

MasonryFrame

Automobile/Motorcycle Form

Name:

Social Security #:

Date of Birth (MM/DD/YYYY):

Street Address:

City:

State:

Zipcode:

Email:

Current INS. Co.:

If cancelled (MM/DD/YY):

Home Number:

Work Number:

Own Home:

Coverage is needed by (MM/DD/YY):

Vehicle Information:

Year:

Make:

Model:

Driver 1:

Name of Driver:

License #:

Social Security #:

Occupation:

Driver 2:

Name of Driver:

License #:

Social Security #:

Occupation:

Driver 3:

Name of Driver:

License #:

Social Security #:

Occupation:

Driver 4:

Name of Driver:

License #:

Social Security #:

Occupation:

List below any of the following by driver
Accidents, Suspensions, Revocations,
D.W.I., Tickets within the last 5 years:?

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