Skip navigation links
POLICYHOLDERS
AGENTS
PROVIDERS
CUSTOMER SERVICE
ECOMP
Brickstreet ad
Skip Navigation Links
BrickStreet 360°
Forms
Obtain CoverageExpand Obtain Coverage
Publications
StreetSelect PPOExpand StreetSelect PPO

Obtain Coverage

Obtaining coverage from BrickStreet is a simple process. You can apply through your local BrickStreet Insurance agent with forms they provide or you can complete the applications below.  

Start by clicking on the first link to get all the instructions you need to complete the application for coverage. Complete the coverage application and fax it to BrickStreet’s Policy Intake unit at 304.941.1152.

Appointed Insurance Agencies
Application for Coverage