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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:_________

Department of Financial Services

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