Vendor / Exhibitor Application

Client Information
Insured Name:*
Trade Name:
Address:(No PO Boxes):*
Suite, Floor, ect..:
City:*
State - Zipcode:*
Form of Business:
Individual Partnership LLC Trust Other
If Other:
Number of years you have been in business as a vendor:
Provide a list or description of the products you sell, handle, or display in your operations*:
Contact Information
First Name:*
Last Name:*
Phone:*
Email:*


Operations to be Insured
Which of the following best describes the area in which you conduct the operations to be insured:
Trailer - If patrons enter the trailer, give the dimensions:
Food Trailer - Number of trailers utilized at one time:
Game Trailer - Number of games utilized at one time:
Tent - Give the dimensions:
Booth - What is the height of your booth/display? Dimensions:
Push Cart - Number of carts utilized at one time:
Out Door Area - Give the dimensions:
Other - Please describe and provide dimensions:

Event Information (Single Event Coverage)
Event Information
Event Name:*
Event Start Date:*
 MM/DD/YEAR
Event End Date:*
 MM/DD/YEAR
Hours of Event:
Venue Name:*
Venue Contact:*
Venue Contact Email:*
Venue Contact Phone:*
Address:*
Address Additional:
City:*
State, Zipcode*


Event Information (Six Month or Annual Coverage)
If you are applying for this coverage you will need to answer the following:
New or Renewal:
Desired effective date:
Desired end date:
Note: Coverage will not be made effective prior to the date that the enrollment form and
payment are received by CSI.
Number of shows you will attend during the coverage period:
Do you attend more than one show simultaneously?
Name of Event:
Date(s) of Event:
Venue Name:
Address:
City:
State, Zipcode


Additional Insureds
Additional Insured
Name:
Address:
City:
State, Zipcode:
Phone:
Fax:
Email:
Relationship: Artist - Owner - Sponsor - Government




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 CSI Insurance?
Preferred contact method
 Email - Phone - Fax
Applicant Signature:*
Applicant Title:*