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* License Application Link *
* Disability Application Link *

To Apply For License Coverage:

  • Right click the License Application Link above and save the word document to your computer.
  • Open the word document and fill out the fields as appropriate.
  • Save the filled-out version on your computer.
  • Send an email to Ralph at Rjmellusi@sealawyers.com with the filled-out word document attached.

To Apply For Disability Coverage:

  • Click the "Disability Application Link" Link above.
  • Fill out and submit the form.
29 Broadway Suite 2311 New York N.Y. 10006-3212 / Business 212-962-1590 / 1-800-280-1590 / Cell 917 584-4665     © 2011 R.J. Mellusi & Co.