POLICY RECOMMENDATIONS(Please check any you are interested in)
Hired & Non-Owned Auto
1) Copy of Waiver
2) Copy of Safety Rules
3) Copy of written emergency & training procedures
4) Business Plan (New Business Only)
5) Resume (New Business Only)
6) Currently dated loss runs for the last 5 years
7) Facility Diagram
Section 1: COMPANY INFORMATION
How did you hear about us?
Date of Birth:
Facility Indoor or Outdoor?
Does the applicant operate any other business from this location?
Description of Business:
Is named insured an:
Years in this business:
# of Setups Owned:
# of Full Time Employed Operators:
# of Part Time Employed Operators:
Names of all operators:
If independent contractors are ever used to operate, est/ annual costs for such labor = $
Operation of Device(s) is:
Fixed site only - provide complete address
Mobile - list ALL states where operation anticipated:
Do you ever process payment cards?
Estimated annual number of payment card transactions:
Create Password (this will allow you to access you application at a later time) :
Please make sure that you have completed everything to the best of your knowledge before going to the next page.