Haines Insurance Document Downloads

If you are a current customer, we have placed these frequently used documents on this site for your convenience.

Simply download the form and print it out, complete the form and fax to 410-658-6369 or email to ken@hainesins.com.

Physician's Report
physicansreport2004.pdf

Authorization Agreement for EriexpressPay
eriexpresspay.pdf

Commercial Driver Questionnaire
commercialdriverquestionnaire.pdf

Authorization Agreement for Check-Matic Plan
checkmaticauthorization.pdf

Additional Driver Questionnaire
additionaldriver.pdf