Special Events Quote Form

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Sample List of
Special Events:

Auto Shows, Concerts, Sporting Events, Proms, Dances, Dog Shows, Parades, Ethnic Celebrations, Horse
Shows, and Weddings.

Please take a moment to fill out the form below and one of our representatives will contact you with a free, no-obligation quote. This information will be kept confidential and will be used for quote purposes only.

* All fields required.

General Information
Business/Company Name:
The entity to be insured is a:
Contact Name:
Address:
City:
State:	Zip:
Phone:	Fax:
E-mail Address:

Event Date / Location(s)
Date(s) of your event:
Event Location (Address):
City:
State:	Zip:

Event Information
How many people will attend event?:
Will admission be charged?:	Yes No If Yes, how much per person?: $
Charges other than admission?:	Yes No (i.e. - food, drink, merchandise etc.)
Estimated total gross income from all event-related charges:	$
Will alcohol be served?:	Yes No Served by: Your Employees Volunteers
Please describe any entertainment, special exhibitions, organized sporting events, or competition that will take place at event:
Will transportation or lodging be provided?:	Yes No
Are you required to name additional insureds on this insurance?:	Yes No

Additional Comments or Questions

Please click the "Submit Quote" button to send your quote request. No coverage is in effect until bound by an insurance carrier. This is a request for quotation only.

Phone: 678.297.7977 Toll Free: 1.800.378.0766 Fax: 678.297.9575

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