[contact-form-7 id=”1055″ title=”Annual Productions”]

Application Form

Please complete this form and we will contact you with a quote

Applicant Information:

Insured Name *

Entity Type *

Entity Type

Primary Address (No PO Boxes) *

City *

State *

Zip *

Mailing Address: (if different from primary)

City

State

Zip

Contact Name *

Phone *

Email Address

Website

Federal ID #

OR Social Security #

Under Writing Qualification:

Will any production take place outside the US or Canada? *

Will any production take place outside the US or Canada(Required)

If yes, Please explain

Insurance History

Any Insurance declined or cancelled in the past 3 years(Not applicable in MO)?

Any Insurance declined or cancelled in the past 3 years(Not applicable in MO)(Required)

If yes, Please explain

Any Prior Insurance Coverage?

Any Prior Insurance Coverage(Required)

Are there stunts for hazardous activities?

Are there stunts for hazardous activities?(Required)

Description of your typical stunts

Production Detail

Years of Experience *

Annual Gross Production Costs($) *

Maximum Budget Per Production($) *

Number of Productions per Year *

Number of employees *

Coverage Limits

Props, Set & Warddrobe *

Misc, Rented Equipment *

Owned Camera Equipment *

Auto

Do you rent cars?

Do you rent cars?(Required)

Do you rent motor homes?

Do you rent motor homes?(Required)

Captcha