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QUOTE REQUEST - Contact Information |
| Organization Name: |
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First Name: |
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Last Name: |
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Address: |
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City: |
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State: |
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Phone: |
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Zip Code: |
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E-mail: |
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Confirm E-mail: |
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| Website: |
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| Currently
Insured With? |
(or write NONE) |
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| Gross Receipts: |
(please tell us your estimated income before your expenses) |
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How many swim instructors do you have: |
Owners:
Employees:
Independent Contractors (1099):
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| How many square feet is your
office (if you have one)? |
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| What type of coverage are
you seeking? |
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| Do you teach any of these: |
Scuba:
Diving:
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| Who do you teach? |
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| How many of each of the
following do you teach? |
Children (0-14 years old):
Children (15-17 years old):
Adults (18+ years old):
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To qualify
for the Youth Sports programs, you must teach only children 17 and
younger, but we have options if you teach adults too. |
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| Are you certified as a swim
instruction? |
Please let us know who certified you or write "NONE" |
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| Do you teach at
a pool that you own? |
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Description of
Organization (what you teach): |
If you teach water polo and and swimming, please let us know
in the box above. |
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Do you have any other information
about your business, or comments that you would like to
share? Please place special requests here. If you have any special
events or fundraisers planned, please let us know the estimated dates and
the type of event below. |
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Someone will contact you about your insurance request to go over the
coverage and options usually in the same day. |
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NO COVERAGE IS BOUND,
OFFERED, ISSUED THROUGH THIS ELECTRONIC COMMUNICATION, ALL POLICIES MUST BE
UNDERWRITTEN AND APPROVED BY THE CARRIER. DO NOT CANCEL YOUR CURRENT
INSURANCE. |
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Swim School Insurance - Fitness
Studio Insurance - Gym Insurance - Athletic Camp Insurance -
Athletic School Insurance - Cheerleading
Camp Insurance - Day Camp Insurance Camp
- Youth Sports Copyright 2015 Stratum
Insurance Agency, LLC |
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