Name Phone 6650 Reseda Blvd Suite #108 Reseda, CA 91335 contact@gisinsure.com		WEDDING INSURANCE First Name: Last Name: Business Name: Mailing Address: Mailing City: Mailing State: Select... Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Mailing Zip Code: Phone Number: Fax Number: E-Mail Address: Who Referred You To Our Site? UNDERWRITING INFORMATION   Event Address:   Event City: Event State: Select... Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Event Zip Code: Please Describe The Special Event: Please Describe Your Experience For Past Special Events: Number of Days Event Will Run: What Date Do You Expect The Event To Begin: Estimated Attendance Per Day: Total Estimated Participants: What Is The Maximum Capacity Of The Event Location: Total Gross Receipts For The Event: Any Celebrities To Be Present? yes  no   Type Of Seating: Reserved  General Admission  Crowd Control & Protection: Ushers  Security, Not Armed  Security, Armed  Off Duty Police, Not Armed  Off Duty Police, Armed  Police, Not Armed  Police, Armed  Guard Dogs  Will Bleachers Or Platforms Be Used? yes  no   If Yes, Are They: Fixed  Portable  Does The Special Event Involve Fireworks? yes  no   Does The Special Event Involve Amusement Rides? yes  no   Does The Special Event Involve Food Sales? yes  no   Does The Special Event Involve Alcoholic Beverage Sales? yes  no   Is This A Sponsored Event? yes  no   Business License Number, If Applicable: License Type, If Applicable: Years of Experience: How Many Years Have You Operated Under This Business Name? Have You Uses Any Other Business Name During The Past 5 Years? No Yes   Losses-Claims In The Past 5 Years:  none  one  two  three  four  five    If Yes, Description, Type & Amount Of each loss-claim Liability Limits Requested: $300,000   $500,000  $1,000,000 $2,000,000