Event insurance contact form


Your name
Business Type
E-mail address	We may send you information from time to time about insurance generally and special offers. If you do NOT want to receive it check and we'll only send details about this enquiry/policy.
Address line 1
Address line 2
City
State/County
Post code
Telephone No.
Type of contract	If an event - estimated visitors
Current insurer	Renewal date
	For bouncy castles we need to know: If used on licenced premises, if they have slides, if dry hire allowed and if adult/ child
Comments contract, details of equipment etc
Have you any specific demands and needs?	I have no specific demands and needs
Declaration I have completed the form to the best of my knowledge and belief. I have made a full disclosure of all material facts. I have read and understood the Important information below. I understand that there is no cover in force until confirmed by B. Portwood & Co Ltd, a satisfactory proposal form completed and accepted and payment of the premium made - either in full or an instalment plan set up acceptable to B. Portwood & Co Ltd.

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