Gun Shop Information
Rifle Pistol Range Information
Revenue, Sales and Operations Information
Special Event Information
COMMERCIAL AUTOMOBILE INSURANCE
PRIOR LOSS INFORMATION
OTHER BUSINESS PURSUITS
OHIO"Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud."
OTHER STATES AND TERRITORIES other than HawaiiAny person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects the person to criminal and [New York: substantial] civil penalties. (In D.C., Louisiana, Maine, Tennessee, Virginia, and Washington, insurance benefits may also be denied.)
The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.
Questions? 877-244-9090Kevin Morency | firstname.lastname@example.org Morency & Associates Inc., 1194 Long Hollow Pike, Gallatin, TN 37066Fax: 615-452-6580https://insurancegunclub.com/