TULIP Application

TULIP - Facility Tenant Users Liability Insurance Application
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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.
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NY License # BR-1001302

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

Rows	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