Fillable Form L-LOC: BRANCH LOCATIONS: (Arizona)

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Form L-LOC: BRANCH LOCATIONS: (Arizona)

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FORM L-LOC (Rev. 06/2018)
Licensing Section
Arizona Department of Insurance
100 North 15
th
Avenue, Suite 102, Phoenix, Arizona 85007-2624
Phone: (602) 364-4457 | Toll-free: (877) 660-0964
Web: https://insurance.az.gov | E-mail: Licensing@azinsurance.gov
Form L-LOC: BRANCH LOCATIONS
This form is only for use by rental car agents and self-service storage agents
ARS §§ 20-331(B) and ARS § 20-332(B) require rental car agents and self-service storage agents to
notify the Department of Insurance of each location where business will be transacted under the
license at least 30 days before conducting business at each location. Use this form to ADD or
DELETE locations.
Licensee’s Name
AZ Insurance License #
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
Physical Street Address ADD DELETE
City
State
Zip Code
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Title
Telephone number
Email address:
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Form L-LOC: BRANCH LOCATIONS: (Arizona)

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Completed 12 August 2020

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