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Company Info
General Info
Policy Claims
Supplements
Equipment
Fraud Page
Confirmation
PLEASE WAIT WHILE WE PROCESS YOUR APPLICATION
In order to process your application we need you to attach the following documents:
Completed Application with all Questions Answered
Loss Runs (5 years)
No loss letter if operating with no insurance
Copy of rental agreement or waiver
Picture of signage with hold harmless wording (Pay for Play Only)
Safety Rules
WARRANTY
(Applies to all parts of this application and attachments submitted)
It is hereby understood and agreed that if insurance is issued by virtue of completing this application and any applicable supplemental applications, the Insurance is only issued on the reliance on the applicant’s warranty of answers to the questions above and on any such supplemental applications. If, at the time a certificate/policy is issued and ANY OF THE ABOVE WARRANTIES IS IN ANY RESPECT INCORRECT, INCLUDING CLAIMS OR GROSS RECEIPTS, THE COVERAGE AFFORDED UNDER THE CERTIFICATE/POLICY shall, without notice to the applicant, immediately and automatically cease, & the certificate/policy shall BECOME NULL AND VOID. Warranties will survive a certificate/policy if issued.
Person Applying:
Title:
Date Submitted:
Terms of Agreement:
By checking this box, I hereby agree to the terms of filling out this application, and I also announce that I have filled this application out with the best of my knowledge.
By signing below, I hereby agree to the terms of filling out this application, and I also announce that I have filled this application out with the best of my knowledge.
Draw your signature
IP: 18.222.10.9
Please make sure that you have completed everything to the best of your knowledge before going to the next page.