Please click on a link below to make a change on your Auto or Property policy (or use the form at the bottom of this page for all other service requests).

	Auto Policy Change Property Policy Change

This portion of the site is for the convenience of our customers. It will be continuously updated to increase your ease of doing business with us. Please feel free to provide us with any suggestions or recommendations you might have on how we can increase the value of this site for you.

Click Here For Access to our 24/7 Service Center for Allied and Progressive.

Service Request Form

Select the items that apply, and then let us know how you want to be contacted.

Send automobile identifications cards for the vehicles on my policy.
Send a certificate of insurance to the business listed in the remarks section below.

Send a binder/proof of insurance to the bank listed in the remarks section below.                                      (Please also list the vehicle or property that this is requested for.)

Please contact me in regard to the question I have listed in the remarks section below.

Have a salesperson contact me regarding:
        Life/Health Insurance  Medicare Supplement/Long Term Care Insurance

        Home/Auto Insurance    Business Insurance  Other Reason  

Name
Policy Number
Company
Address
E-mail
Phone
Remarks

This is currently for service requests only, no request for new or additional coverage is to be assumed as accepted or provided. Any applicable coverage will be subject to approval by Kouri Insurance Agency. Please note that we cannot guarantee the privacy of email communication. Information of a sensitive nature should be provided by phone -336.6303, or fax -336.0050. Thank you for your understanding.