Adorama Rental Company's Equipment Insurance Protection Plan Application

Adorama Rental Company's Equipment Insurance Protection Plan Application

Film Emporium is pleased to offer Adorama Rental Company’s Equipment Insurance Protection Plan thru U.S. Specialty Insurance Company for rented equipment valued up to $50,000. These policies cover both damage and theft with a $500-$1000 per claim deductible and can be as long as 31 days.
This insurance coverage is immediately earned at inception of your rental. A cancellation is possible only if Adorama confirms your rental did not occur.
APPLICANT INFORMATION
First Time Adorama Rental Company Renter?*

YesNo
Your Company or Name as per the Rental Contract*
Your Adorama Rental Company order number (as listed on your rental contract)*
Your Address as per the Rental Contract*
Street, City, State, & Zipcode
Phone Number*

Area CodePhone Number
E-mail*

Confirmation Email
Equipment Replacement Value as per the Rental Contract*
How Many total days are you renting the equipment?*
Pick-up Date as per the Rental Contract*

MonthDayYear
Date
Drop-off Date as per the Rental Contract*

MonthDayYear
Insurance exp. is 12:01am. If your last day or filming is April 25th use April 26th as the last day of coverage (as it will expire on 04.26 12:01am).
Total Premium Due:*
Total Premium Due Widget

Total Premium Due*

USDInsurance Premium

Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
This insurance coverage is not refundable and immediately earned at inception.
Should be Empty: