Weather Application

IF YOU ARE A VENDOR OR EXHIBITOR PLEASE DO NOT FILL THIS APPLICATION OUT
CLICK THIS LINK FOR VENDOR / EXHIBITOR COVERAGE
Client Information
Organization Information
*Company/Organization:

Entity Type:
*Address:(No PO Boxes):

Suite, Floor, ect..:
*City:

*State - Zipcode:
 

Contact Information
*First Name:

*Last Name:

*Phone:

*Email:



Event Details
*Event Type:

*Event Name:

*Venue Name:

*Venue Contact Phone:

*Address:

Address Additional:
*City:

*State, Zipcode
 
*Daily attendance:

*Estimated Total Attendance:

*Description of Event:

Other Details
*Gross Revenue:$:
Enter 0(zero) if you will not be generating revenue at this event.
*Expenses:$:
Enter the total dollar amount you expect to spend on this event.


Coverages
Please Choose One Of The Below Peril Coverages.
Type of Coverage:
Additional Required Information:
Event Coverage Dates
Coverage Start Time Coverage End Time Per Day Sum Insured
Event Day 1:
Event Day 2:
Event Day 3:
Event Day 4:
Event Day 5:


Additional Insureds
Will you need to add any additional Insured?


FRAUD STATEMENT Signing this application does not bind the Applicant or the Company to complete the insurance, but it is understood and agreed that the information contained herein shall be the basis of the contract should a policy be issued. If any of the above questions have been answered fraudulently or in such a way as to conceal or misrepresent any material fact or circumstance concerning this insurance or the subject thereof, the entire policy shall be void.
*I/We have read the above and agree that to the best of my/our knowledge and belief same fully represents the true statement of facts.


Applicant
How did you hear about us?
Preferred contact method
Email - Phone - Fax
*Applicant Signature:

*Applicant Title: