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Applications and Forms
Commercial Lines
Email: CLQuote@thepottergroup.com
Fax: 716-662-4723
Personal Lines
Email: PLQuote@thepottergroup.com
Fax: 716-662-4734
Instructions for use:
1. Open form and complete directly on your computer.
2. Print or save the form.
3. If submitting more than one form, continue to complete all forms necessary and save to your computer or print.
4. Email all forms as attachments in one email to the appropriate email address or fax all forms to the
appropriate fax number.

BE SURE TO INCLUDE YOUR NAME & CONTACT INFORMATION IN YOUR COVER EMAIL
OR ON YOUR FAX COVER PAGE.
Click on the link above for state specific forms.

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