Premier Services - The Insurance Experts

Event Insurance Application Form
(Quotes will be provided for Pennsylvania and New Jersey)

Name of organization:

Contact name:

Address of contact person:

City, State, Zip Code:

Phone:

Fax:

E-Mail:

Date(s) of event:

Hours of event:

Location of event:

City, State, Zip Code:

Is this event: Indoor Outdoor

Approx. square footage of room or outside area:

Number of people to attend event:

Fire code limit of the number of people that room, hall or building can hold:

Will alcohol be served? Yes No
Limits of liability needed:

Please describe in detail the full purpose and operation of the event:

Do you have quotations from other companies? Yes No

Would you like a quote from us for the same coverage for easy comparison? Yes No

Who is the insurance company?

What was the price quoted?

How did you hear about us?

Additional Comments: