TULIP Application

TULIP - Facility Tenant Users Liability Insurance Application
Click here for Insrance Terms & Definitions.
APPLICANT INFORMATION
How did you hear about us?*
Select how you found our website.
Facility / Venue Name *
Note: Named insured will be Tenant Users of [name of facility]
Entity Type*
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*

Confirmation Email
Website
Description of your operations:*

Additional Information, Comments
Additional Information or Comments, if necessary, can be provided.
Would you like to receive our quarterly newsletter?*

YesNo
NY License # BR-1001302

CA License # 0I36156 - dba in CA as New York Film Emporium Insurance Services
Should be Empty:

	Yes	No
Security
Parking (valet, attendants)
Concessions
Liquor
Ushers ( if yes, number provided)
Access to cooking facilities on premises?

TULIP - Facility Tenant Users Liability Insurance Application