Providing auto, home, business, motorcycle and life insurance to Mansfield, Blossburg, Wellsboro, all of Pennsylvania and the Southern Tier of New York since 1977.

If you have any questions about filling out a form on our website call our office  570-662-7300.

Please mail forms to
Wert Insurance
PO Box 485
Mansfield, PA 16933

Erie Insurance forms
1. Checking/savings account change form – Form 117A
2. Family auto driver questionnaire – Form 1297
3. Commercial auto driver questionnaire – Form 1967
4. Life Insurance beneficiary change form – EFL2333
5. Uninsured motorist rejection of stacked limits – Form 2045
6. Underinsured motorist rejection of stacked limits – Form 2048
 

Miscellaneous forms
1. ACORD Cancellation request – ACORD 35
2. BlueCross NEPA – Medical questionnaire – B200
3. BlueCross NEPA – Enrollment form – B0044
4. Aetna enrollment form – Aetna 68753