Wedding Insurance Request
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
Format: (000) 000-0000.
Spouses Name
First Name
Last Name
Wedding Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Wedding Location
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many attendees
Will you be serving liquor?
Yes, served by caterer or professional bartender
Yes, self serve or BYOB
No
Will there be any water activities? (Swimming, boating, fishing, etc.)?
Yes
No
Will there be any firearms used at the event?
Yes
No
Will there be any overnight camping or guests staying on the premises? (Not including hotel or residence)
Yes
No
Will there be fireworks?
Yes
No
Will event end by 3 AM?
Yes
No
Please list any additional insured that need to be listed. (ex. Venue, Planner, Property Manager, etc.)
Please list any special requirement you have for this insurance policy.
Please give a description of the wedding/reception events. (I will use this to make sure all of the correct coverages are quoted, but we will go over what they do and if you actually want them later)
Please select a time to go over coverages. I want to make sure your future starts the best that it can!
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