Name: Landis Insurance Agency
Address: 1238 West Lincoln Highway, Coatesville, PA, 19320, US
Telephone: (610) 383-1451

Request Type?
- Refinance
- Verification
- Loan Transfer
Customer Name
Customer Policy Number
Customer Property Address
Is an escrow account being set up for the Premium payments?
- Yes
- No
Replacing All Loans?
- Yes
- No
If no, explain:
Confirmed Closing Date
MM slash DD slash YYYY

*we cannot make changes until there is a confirmed closing date
Mortgagee Clause
Loan Number
Requester's Name
Requester's Email address
Upload Borrower’s Authorization
Max. file size: 59 MB.
**If all the needed information has been provided, the requested documents will be emailed within 2 business days. If information is missing, a follow-up email will be sent within 2 business days.**
Additional Information

Insuring Coatesville & All of Pennsylvania

Call (610) 383-1451