Party Equipment Rental Online Application

Section 1: POLICY RECOMMENDATIONS

(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



• Submission Requirements
• 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

Section 1: General Information

How did you hear about us?     Choose One Bing Customer Referral Email Blast Google Manufacturer Other Postcard Social Media Trade Show Yahoo

Are you an ERS or Inflatable Office customer? (You may be eligible for a discount)

Yes No

2. Corporate Name:

3. Effective Date:

4. Business Name:

5. Entity Type: Individual Partnership Corporation Sole Proprietorship LLC Examples: Individual: Jane Doe DBA Jane's Bouncers, Partnership: Jane Doe & John Smith, Corporation: C Corp or S Corp, LLC: Jane's Bouncers LLC

6. First Name Last Name

7. Date of Birth:

8. Phone Number:

9. Fax:

10. Website:

11. Email:

12. Mailing Address:

City:

State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code:

Location Address:

City:

State: Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code:

13. Year Business Started (Month/Year):

14. FEIN/SS#:

15. Years of Management Experience? (does not have to be with inflatables)

16. Type of Management Experience:

Do you ever process payment cards?

Yes No

Estimated annual number of payment card transactions:

Section 2: Description of Operations

Type of Operation

Your employees present at event
with operators Not operated by your employees
without operators Some events are operated by your staff & some events are not
both

1. Describe your operations- Check all that apply:   
Events where you charge each participant Backyard Birthday Parties     Parks     Corporate Events     Street Fairs     Carnivals Entertainment Services Other:

For Street Fairs, Carnivals, Events where you charge each participant and other please attach a copy of the signage/waiver.

Do you or your company own/operate any Street Fairs, Carnivals or Midways?

Yes No

Create Password (this will allow you to access you application at a later time) :

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