Vendor Application – Insurevents

Policyholder Information
Your Company Name

Insurance Brokers- DO NOT put your name here. You will be asked for that information on the next screen.
Your Full Name*
Address*
Street Address City State ZIP Code
Primary Phone Number (Preferably Mobile)*
Can this phone accept texts?*
- Yes
- No
Email (If you are an insurance broker, use your email & not your clients)*
Enter Email Confirm Email
Hidden
obsolete 8-20-19
Website
How many years of experience do you have?*
Are you a Non-Profit Corporation?
- Yes
- No
Who referred you to us?
Are you an insurance agent/broker applying for a quote on behalf of your client?*
- Yes
- No
For Insurance Agents & Brokers Only
Your Insurance Agency Name

Remember to enter YOUR email address above, NOT your client's email. Otherwise they will receive automatic notifications and our quote instead of you.
Agents First Name
Agents Last Name
Address
Mailing Address City State / Province / Region ZIP / Postal Code Country
Telephone
Remember to enter your email address on the previous screen in lieu of your client's email.

General Information
Products Sold/Exhibited*
Size of selling area (in feet)*
Estimated attendance at your booth*
Start Date of Your Policy (First Set-Up Date)*
Your policy cannot start any sooner than the next business day after application submission.
MM slash DD slash YYYY
Which Policy Term are you purchasing?*
- 5 Days / $175 Premium
- 14 Days / $250 Premium
- 1 Month / $300 Premium
- 6 Months / $425 Premium
- Annual / $500 Premium
Are you involved in any of the following: Body piercing or tattooing; Fireworks sales & displays; Hot wax impressions; Live animals; Massage; Medical testing; Motor sports activities; Nutritional/health supplements; On-site installation/service/repair of products; On-site equipment rental; Oxygen; Aromatherapy; Time share sales; Tobacco products; Vehicles in motion; Watercraft exhibits on water; Weapon sales; Weight-loss plans or products; Medical marijuana and/or paraphernalia; Catering Companies; Christmas tree lots; Corn or Hay mazes; Disc-Jockeys for events with over 200 attendees; Haunted attractions; Live Bands; Mechanical or inflatable amusement devices; Food Truck.*
- Yes
- No
Explain your Yes answer*
Your previous Insurance company*
Premium Paid
List any previous claims*

Information on your 1st upcoming event
Name of Event or Description*
Event Dates*
Name of Location or Promoter*
Their Contact's First & Last name*
Contact's Email
Their Telephone
Fax
Address*
Mailing Address City State / Province / Region ZIP / Postal Code Country
Venue's/Promoter's additional insured wording (found in your rental agreement)
Does the contract require a Primary & Noncontributory endorsement?*
Higher rates apply if you need it.
- Yes
- No
Does the contract require a Waiver of Subrogation endorsement?*
Higher rates apply if you need it.
- Yes
- No
Upload a copy of your vendor contract with the Promoter/Location
Acceptable file types: pdf, jpg, gif, png, doc, docx, xls, xlsx. Maximum File Size: 128MB.
Drop files here or

Accepted file types: pdf, jpg, gif, png, doc, docx, xls, xlsx, Max. file size: 256 MB.
Any additional information we need to know?

Policyholder Information