Weather Insurance

Client Information

Organization Information

Company

Entity Type

Address

Suite, Floor, Etc.

City

State

Zip Code

Contact Information

First Name

Last Name

Phone Number

Email Address

Event Details

Event Type

Event Name

Venue Name

Venue Contact Email

Address

Venue Contact

Venue Contact Phone

Address Additional

City

State

Zip Code

Event Website

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? YesNo

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 EmailPhoneFax

Applicant Signature

Applicant Title

Weather Application