DISKETTE ORDER FORM

IF YOU ARE UNABLE TO DOWNLOAD THE FILES FROM THE DEPARTMENT’S WEBSITE AND YOU DO NOT HAVE ACCESS TO INTERNET E-MAIL, YOU CAN OBTAIN A DISKETTE CONTAINING BOTH THE LOTUS 1.2.3 AND MICROSOFT EXCEL VERSIONS OF THE INSURANCE AVAILABILITY SURVEY WORKSHEETS.

TO DO SO, PRINT THIS DOCUMENT, COMPLETE THE INFORMATION BELOW AND MAIL TO:

NEW YORK INSURANCE DEPARTMENT
ATTN: PROPERTY BUREAU
              MARS-IA
25 BEAVER STREET
NEW YORK, NY 10004

 

COMPANY NAME: ______________________________________
PERSON’S NAME: ______________________________________
TITLE: ______________________________________
STREET OR PO BOX: ______________________________________
CITY: ______________________________________
STATE: _________________________  ZIP:_________