Special Event Quote Form - The Zutz Group

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Special Event Quote Form

Contact Information
Business Name:
The entity to be insured is a:
Contact Name:
Address:
City:
State:	Zip:
Phone:	Fax:
E-mail Address:

Event Information
1.	Date(s) of your event:
2.	Event Location or Address: City: State: Zip:
3.	Will there be other locations? Yes No (If Yes, list additional locations in Comments section below.)
4.	How many people will attend event?
5.	Will admission be charged? Yes No
	If Yes, how much per person? $
6.	Charges other than admission? (i.e. food, drink, merchandise etc.) Yes No
7.	Estimated total gross income from all event-related charges: $
8.	Will alcohol be served? Yes No
9.	Served by: Your Employees Volunteers
10.	Please describe any entertainment, special exhibitions, organized sporting events, or competition that will take place at event:

11.	Will transportation or lodging be provided? Yes No
12.	Are you required to name additional insureds on this insurance? Yes No

Additional Comments

Please click the "Submit Quote" button to send your
quote request.
This is a request for quotation only. No coverage is in effect until bound by an insurance carrier.

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