HOA/Condo Association Certificate Request

Community Association Certificate Request Form

Please enter the following information to request an Associations Certificate from American Benefits Insurance. Borrower information must be complete and accurate to produce a certificate. Requests are processed and faxed within 1-2 business days. If you have any questions, please feel free to contact us at (503) 292-1580.

HOA/ Condo Association Certificate Request

1. Association or Home Owners' Information:
Condo or Homeowner Association*
Closing Date*
MM slash DD slash YYYY
2. Borrower Information
Number of Borrowers*
- 1
- 2
Borrower / Unit Owner Name #1
First Last
Borrower / Unit Owner Name #2
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Unit (optional)
Borrower Email*
Borrower Phone*
3. First Lender / Mortgage Clause Information
Lender Name*
Name
Lender Address*
Street Address Address Line 2 City State ZIP Code
What is the mortgage clause type?*
- ISAOA
- ATIMA
- ISAOA/ATIMA
- None
Why are you requesting the certificate?*
- Refinance
- New Purchase
- Annual Certificate Update
Account Loan Number
4. Second Lender / Mortgage Clause Information
Lender Name
Name
Lender Address
Street Address Address Line 2 City State ZIP Code
Account Loan Number
5. Your Contact Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Unit (optional)
Email*
Phone*
Fax
User Flood Info
- Acord
- Declarations Page
6. How would you like to receive your certificate?
Method to receive*
Please select at least one method.
- Notification Email
- 1st Notification Fax
- 2nd Notification Fax
Special Instructions
(Standard Request processed in 1-2 business days)
For Rush Delivery*, Please complete and submit the form above, then pay after you click submit.

*Rush orders are processed during normal business hours (M-F 9am-5pm).

Delivery will be within 4 regular business hours following an order. (Example: an order on Monday at 9am will be delivered by Monday at 1pm, while an order on Friday at 4pm may not arrive until Monday at 12noon.)
Would you like Rush delivery?*
- Yes
- No
Rush delivery add on
Price:
Total to pay now
$0.00
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name