New Coverage Application

How did you hear about us?
Direct Mail
NAIFA Colleague Referral
Miscellaneous
NAIFA Organization Referral
Other website
Space Ad
Search Engine
NAIFA State Association
Trade Show

The application is in PDF format and requires Adobe Acrobat Reader to download.

New! The application is in a new interactive PDF format that allows you to complete it on your PC before you print it.

Download Application For Agency

After you print and complete the application, you can submit it by:

1. Mailing the completed application to:
Affinity Insurance Services
Attn: NAIFA Professional Liability Program
159 East County Line Road
Hatboro, PA 19040-1218
2. Faxing the completed application to: 1-877-443-9183

Download Adobe Acrobat Reader, free. This link will open the Adobe website in a new browser window.



McAfee Secure sites help keep you safe from identity theft, credit card fraud, spyware, spam, viruses and online scams


Insurance License Information
© 2010 Affinity Insurance Services, Inc.
Apply Now NAIFA-endorsed Professional Liability Insurance Program