Talamas Equipment Insurance Protection Plan Application

Talamas Equipment Insurance Protection Plan Application
Film Emporium is pleased to offer Talamas' Equipment Insurance Protection Plan thru Houston Casualty Insurance Company for rented equipment valued up to $50,000. These policies cover both damage and theft up to 30 day rental periods with a per claim deductible as detailed below:

Equipment up to $24,999 - subject to a 5% of loss / minimum $250 deductible per claim

Equipment up to $50,000 - subject to a 5% of loss /minimum $500 deductible per claim
This insurance coverage is not refundable and immediately earned at inception.
APPLICANT INFORMATION
First Time Talamas Renter?*

YesNo
Your Company or Name as per the Rental Contract*
Your Talamas 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.
Equipment up to $24,999 - subject to a 5% of loss / minimum $250 deductible per claim

Equipment up to $50,000 - subject to a 5% of loss /minimum $500 deductible per claim
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