Clone of Santa Insurance Questionnaire

Entertainer Insurance Questionnaire
General Information
Applicant Name

First NameLast Name
Email
example@example.com
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you operate out of your home or do you have Commercial Space?
Legal Entity
Types of Entertainment Offered:

Other
Business Established Year
Number of employees or sub-Contractors
Detailed information about your business
Website or Social Media Page If you don't have one enter "NONE"
Approx. Replacement Cost of Costumes and Props
Gross Annual Revenue ($)
Current Insurance Carrier or Program
Current Policy Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Desired Effective Date for New Policy

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Do you use Fire or Pyrotechnics in your act?
Do You use animals other than dogs, birds or rabbits in your acts?
Do you have any mechanical ride or any amusement device , such as moon bounce or rock walls?
Do you or any member of the your household an owner of any other business or franchise?
How Did You Hear About RFK?
CREDIT DISCLOSURE
In connection with this request for an insurance quote, Carriers may review your credit report or obtain a credit-based insurance score based on the information contained in that credit report. Carriers may use a third party in connection with the development of your insurance score. Please note that Carriers will not deny coverage based on the obtained insurance score.
By Submitting this Form you acknowledge and accept the above
Should be Empty:

Entertainer Insurance Questionnaire

General Information