Event Weather Insurance Application

Event Weather Insurance Application
Click here for Insurance Terms & Definitions.
APPLICANT INFORMATION
How did you hear about us?*
Select how you found our website.
Insured Name*
The name of your production company or entity (or individual name if not incorporated) you would like to insure. Use the same name as on your rental quote.
Entity Type*
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
E-mail*

Confirmation Email
Website
Description of your operations:*

COVERAGE INFORMATION
Event Coverage Start Date:*

MonthDayYear
Date
Event Coverage End Date:*

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).
Event Start Time:*

:HourMinutesAM/PM Option
Event End Time:*

:HourMinutesAM/PM Option
Hours of coverage needed:*
Example: 5PM to 11PM
Coverage Limit Requested Per Day*

Additional Information, Comments
Additional Information or Comments, if necessary, can be provided.
Would you like to receive our quarterly newsletter?*

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NY License # BR-1001302

CA License # 0I36156 - dba in CA as New York Film Emporium Insurance Services
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EVENT INFORMATION