Photographer PackageApplication FormPlease complete this form and we will contact you with a quotePersonal Information:Insured NameEntity Type Individual S-Corp C-Corp LLCPrimary Address (No PO Boxes) *CityStateZipMailing Address: (if different from primary)Contact NamePhoneEmail WebsiteFederal ID #OR Social Security #Under Writing QualificationWill any production take place outside the US or Canada? Yes NoIf yes, Please explainInsurance HistoryAny Insurance declined or cancelled in the past 3 years(Not applicable in MO)? Yes NoIf yes, Please explainAny Prior Insurance Coverage? Yes NoIf yes, Please provide detail below for each policyDescribe your typical shootsAre there stunts and/or hazardous activities? Yes NoIf yes, please describePhotographer DetailYears of ExperienceAnnual RevenueNumber of shoots per yearNumber of employeesDo you hire freelancers Yes NoIf yes, how many and estimated payCoverage LimitsGeneral Liability1,000,0002,000,000Excess Liability1,000,0002,000,0003,000,0005,000,000Value of owned camera equipmentValue of rented camera equipmentValue of office/studio contentsWorkers compensation Yes NoIf yes, estimated annual payrollDo you wish to be covered? Yes NoCommentsThis field is for validation purposes and should be left unchanged.
