Please download the application of interest, then print it out. You will not be able to complete it online. Once completed, you may fax it 510-222-6162. To insure that your application reaches the correct broker, it is important to list the broker's name on your fax cover page. You may also want to email or contact the broker by telephone to let him/her know that you are faxing over the completed application.
Please try to complete the application as completely and as accuretly as possible. If you need assistance or have a question about the application, please feel free to call our office.
Hayes Insurance Agency 3550 San Pablo Dam Rd. Ste. C El Sobrante, CA 94803 Toll Free Ph: (800) 869.8643 Local Ph: (510) 222.8643 Fax: (510) 222.6162 License #0658980