License Insurance Application

License 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.
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.