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 AND FREE TRADE ZONE UPDATE WORKSHEET.

TO OBTAIN THE DISKETTE, FILL OUT THE INFORMATION BELOW AND MAIL TO:

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

 

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