ISBA Insurance Program Representatives are available to assist you Monday through Friday from 7:30 a.m. to 5:00 p.m. central time except on scheduled holidays. Please allow two (2) business days from receipt of request in our office to process your certificate request.

For your convenience, ISBA Insurance Program certificate request forms are available in both Word and PDF formats.

To complete an electronic Certificate Request and email directly to the ISBA Insurance Program:

1. Click here to Download the Word file.
2. Complete the form at your convenience
3. E-mail completed form to certificaterequest@locktonaffinity.com

To print form, complete and fax/mail to the ISBA Insurance Program:

1. Click here to download the PDF file.
2. Print the form
3. Complete and:
   a. Fax to 913-652-3996
   OR
   b. Mail to:

   ISBA Insurance Program
   P.O. Box 410679
   Kansas City, MO 64141-0679