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Light BulbHelpful Tip: You will create a password at the end of this page that will allow you to come back at any time to fill out your application!

  • (Please check any you are interested in)
    • General Liability
    • Accident Medical
    • Earthquake
    • Inland Marine
    • Worker's Compensation
    • Commercial Auto
    • EPLI
    • Flood
    • Hired & Non-Owned Auto
    • Umbrella
    • Abuse/Molestation
    • Cyber Liability

    • 1) Loss Runs (5 years)
    • 2) No loss letter if operating with no insurance
    • 3) Copy of Rental Agreement / Waiver
    • 4) Safety Rules
    • 5) Pictures of signage with hold harmless wording (Pay for Play Only)
    • 6) Copy of Taxes or Schedule C

  • How did you hear about us?    
  • Are you an ERS or Inflatable Office customer?
  • Examples: Individual: Jane Doe DBA Jane's Bouncers, Partnership: Jane Doe & John Smith, Corporation: C Corp or S Corp, LLC: Jane's Bouncers LLC
  • Do you ever process payment cards?
  • Estimated annual number of payment card transactions:

  • Mailing Address

  • Location Address

  • Desired Effective Date:
  • Describe your operations- Check all that apply:   
    Backyard Birthday Parties     Parks     Corporate Events     Street Fairs     Carnivals    
    Events where you charge each participant    Other:
  • Do you or your company operate any Street Fairs, Carnivals or Midways?
  • Create Password (this will allow you to access you application at a later time) :