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Need to submit a form?

Do so securely online now!

Find the online form you need to complete, submit it online, and a licensed agent from our team will reach out to you shortly!

General Forms for All Product Lines

Confidential Information and Document Uploads

Credit Card Payment Authorization

Banking (EFT) Payment Information

Don't see the form you need?

Please select the type of insurance you are looking to submit a form for:

Small Business / Commercial Insurance

Small Business/Commercial Insurance Quote Request Form - For Profit Entities (Click Here)

Use this form when you are requesting an initial quote from Acuhawk Insurance Solutions for your business insurance needs, including General Liability, Professional Liability (E&O), Workers Compensation, Inland Marine (Mobile Property), Business Personal Property, Cyber Liability, Hired and Non-Owned Auto, Employment Practices Liability Insurance (EPLI), or other commercial insurance

Small Business/Commercial Insurance Quote Request Form - Non-Profit Entities (Click Here)

Use this form when you are requesting an initial quote from Acuhawk Insurance Solutions for your business insurance needs, including General Liability, Professional Liability (E&O), Workers Compensation, Inland Marine (Mobile Property), Business Personal Property, Cyber Liability, Hired and Non-Owned Auto, Employment Practices Liability Insurance (EPLI), Directors and Officers (D&O), or other commercial insurance for non-profit organizations.

Secure Document Upload Portal - Commercial Insurance

Use this form when you need to provide a social security number, tax ID number or upload documents such as insurance policy pages, driver's license, income verification documents (prior tax filings, paystubs, etc)

Home / Auto Insurance

Forms coming soon.

Health Insurance

Marketplace/ACA Insurance - New Client Information Gathering Form

Use this form if you are new to Acuhawk Insurance and/or the health insurance Marketplace to provide household information needed to quote your insurance.

Marketplace/ACA Insurance - Open Enrollment Client Information Update Form

Use this form if you are already a client of Acuhawk Insurance and are updating information for your annual Open Enrollment review for the upcoming year.

Group Health Insurance - Census Upload

Use this form to securely upload your employee census information spreadsheet for quoting. Need the blank census itself? Click here for a copy.

Medicare Related Products

Medicare Scope of Appointment (SOA) Form

Use this form if you would like to connect with a licensed agent about your Medicare related needs. This typically must be completed at least 48 hrs prior to a scheduled appointment, if applicable.

Life and Disability Insurance

Disability Insurance Quote Request Form

Use this form when you are requesting an initial quote from Acuhawk Insurance Solutions for your disability insurance needs

Life Insurance Quote Request Form

Use this form when you are requesting an initial quote from Acuhawk Insurance Solutions for your life insurance needs

Pet Insurance

Forms coming soon.

MEDICARE ADVANTAGE NOTICE (Douglas County Nebraska): We do not offer every plan available in your area. Currently we represent 7 organizations which offer 42 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

MEDICARE PART D NOTICE (Douglas County Nebraska): We do not offer every plan available in your area. Currently we represent 4 organizations which offer 8 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program to get information on all of your options.

Please Note:

We are an independent broker agency and have contracts and access to several carriers. Not all carriers have online consumer quoting links available, but direct links are provided below, when available. Your licensed local agent will be able to review your circumstances in depth, identify additional options (if necessary) and answer any questions you may have.

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Tired of online forms and prefer to a more in-depth conversation with a local agent? We can help! See below for appointment options that fit your needs.

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