Policy Service Request

In order to track your requests and serve your policy change needs faster and with greater accuracy, please complete the form below in its entirety.

It is very helpful if you are able to attach any sample documents your requesting party has sent you pertaining to this policy service request.

If you have any questions, please call our office at (518) 960-6600 or email support@roguerisk.com

Insured Information
Contact Person
First Last
Effective Date Needed for this Change?
MM slash DD slash YYYY
Phone*
Email*
Policy Information
Line of Business for Service Request*
- Business
- Personal
Insurance Carrier for Service Request
Policy Number for Service Request

If you don't know - please type "HELP"
Request Information
Type of Service Needed*
You can request multiple service items, as needed:
- Help with Potential Claim
- Add a Property to a Schedule
- Remove a Property from a Schedule
- Add a Driver
- Remove a Driver
- Add a Vehicle
- Remove a Vehicle
- Billing Update
- Other Type of Policy Change
- Cancel Policy
What else do we need to know to properly and promptly resolve your policy service needs?
Upload Any Relevant Documents
Drop files here or

Max. file size: 1 MB.
Drivers Lists | Copies Of Licenses | Etc

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(855) 960-6600

gorogue@roguerisk.com
24 4th Street, Troy, NY 12180

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Insured Information