Quote/Application Forms

Click the orange button above to submit online forms.
To print and fill-out the forms, download the forms from the links below.

  • Auto/Home/Umbrella Insurance
    Indivisual triple set
    [Word] [PDF]
  • Health Insurance



Phone: 770-509-9896
e-mail: info@hasegawainsurance.com



About us

Your Trusted Advisor for Auto, Health, Homeowners, Life, Business Insurance


We are a Japanese insurance agency with 15 plus years experience in the American Insurance industry. We are committed to providing you, our customer, with a full range of services, backed up by our combined experience and technical expertise, which have been developed over many years.

Your Risk is Our Business

We welcome the challenge to assist you with any and all risks. By assessing your risks carefully and rationally, we can recommend and place the best insurance program in the best market for you. Using our knowledge, we can prepare a comprehensive risk management package for you.

We are Insurance Professionals

We are insurance specialists whose main goal is to successfully answer your insurance needs by seeking appropriate solutions, which serve your best interests.

☆ Property and Casualty Insurance, Ocean Marine Insurance and Personal Line Insurance.
☆ Group Health Insurance (PPO, HMO, POS), Long and Short Disability Insurance and Life Insurance.
☆ Financial Service, Term and Cash Value Life, Insurance and Annuities.

Trust and Assurance

Insurance is an enigmatic product. So, our objective is to give our customers a dependable service that wins their confidence.

Independent Insurance Agency

We are committed to working with your by utilizing the highest standards of competence, integrity and dedication. You can rely on us for viable insurance and risk management resolutions because we work with several insurance companies (as oppose to one) who we can approach to provide you with the best coverage at the best price.

A member of Independent Insurance Agent of America and Trusted Choice™

Trusted Choice™ is the smart way to buy insurance.
We represent many insurance companies, so we can offer a variety of choices to customize a plan to meet your unique needs.
Most importantly, a Trusted Choice™ agent isn't an employee of the insurance company, so when you have a claim, we'll be your advocate, not theirs. We serve you first!!


Insurance Broker and Risk Consultant:
☆ Hiroshi Hasegawa, President, (General Risk Consultant)
(770) 509-9896, Ex #3 Email: info@hasegawainsurance.com
☆ Tomoe Cargile, Personal Line CSR
(770) 509-9896, Ex #3 Email: TomoeC@hasegawainsurance.com
☆ Junko (Murai) Kwon, Commercial Line CSR
(770)509-9896, Ex #1, Email: Junkok@hasegawainsurance.com

1) Insurance Program and a Comprehensive Risk Management
We work with you to maintain the best possible choice in insurance policies as an investment in the overall risk management as well as the basic form of protection for your organization.

2) Monitoring the Cost of Insurance
Monitoring program costs and insurance premium with a competitive bidding process and cost containment ideas that include all variable alternatives.

3) Support Your Risk Management Team
Explain insurance coverage and policies you have maintained and how your insurance programs works. Answering any questions your staff may have about the insurance, risk and/or claims management procedures. We will also assist your staff in supervisory position to adequately implement these procedures within your daily operations to establish your internal risk management team.

4) Support and Assist Your Loss Prevention Efforts
We arrange a loss control survey and a meeting by the insurance carriers to assist you in your loss prevention efforts. The survey results are analyzed and evaluated for your organization by our staff. Any recommendations developed by the loss controller are carefully monitored for their compliance.

5) Provide Information about the Risk Management
We monitor trends, legal environment, and insurance market condition, and then provide you with the useful information for your reference.

6) Support Reporting of a Claim
Our customer representatives assist you to make a formal report of the accident or problem to the claim department of the insurance company. We monitor a claim adjusting, and make sure that your claim is paid on a timely manner. We also support you by reviewing the adequacy of claim settlement.

We represent following companies to name a few: