IMPORTANT MESSAGE: COVID-19 UPDATE

Effective 11/23/2020, due to large number of positive COVID-19 cases currently in Topeka and Shawnee County, the staff of Al Janosik Insurance is now working remotely again. We can still be reached by phone and by email. Please be safe and we thank you for your understanding.

Address Change

Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly and we will confirm when completed.

    Personal Information

    First Name:*

    Last Name:*

    E-Mail Address:*

    Primary Phone Number:*

    New Street Address:

    City:

    State:

    Zip / Postal Code:

    Reason for Address Change:

    Is your mailing address the same as the new street address?: YesNo

    Do you own or rent this residence?: OwnRent

    Additional Comments: