Haunted Trails & Hayrides Insurance
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5HAUNTED TRAILS & HAYRIDES INSURANCE
Cossio Insurance Agency
864-688-0121
Fax: 864-603-2348
P.O. Box 5987, Greenville, SC 29606
DIRECTIONS:
DIRECTIONS:
DIRECTIONS:
1. Fill in the application by filling in the blue fields on all pages.
2. Please fill in all the fields with the correct information.
1. Complete the application (all pages) in full by filling in the blue fields.
1. Complete the enrollment form (all pages) in full by filling in the blue fields.
3. Mail the completed quote request form to:
3. Email the application to or Fax to 864-603-2348
Please note that we are unable to provide coverage for the following events: Air Shows, Ballooning Events, Skydiving Events,
War Games, Cattle Drives, Abortion Rights Rallies, Pro Choice Rallies, Protest Events, Dunk Tanks,Trampolines, Moonwalks,
Water Slides, Auto Racing, Motorcycle Racing, Snowmobile Racing, Demolition Derbies,Hot Air Balloons, Bungee Jumping
and Concerts with a Propensity Towards Violence (rap, punk rock, etc).
Section 1: CONTACT INFORMATION
How did you hear about us?
...
Contact Name:
Date of Birth:
Coporate Name:
Business Name:
Do you wish to receive your quote by:
Fax
Email
Mail
Address of Applicant:
City:
State:
Zip:
Section 2: EVENT INFORMATION
Dates of Event
Time(s)
Name of Event
Location of Event
City:
State:
Zip:
Name of Facility:
Does the Facility Carry Liability Insurance?
No
Limits:
Yes
Description of Event
Is this Event Located Indoors or Outdoors?
If Outdoors, is the Area Fenced or Enclosed?
No
Yes
Are you Responsible for Parking?
No
If Yes, Square Footage of Parking Area
Yes
What is the Seating Capacity of the Event?
What is the Estimated Attendance Per Day?
What is the Number of Tickets Printed?
What is the Number of Tickets Sold to Date?
What is the Price of Admission?
What is the Estimated Gross Receipts?
What is the Estimated Total Payroll?
Revised 6/16/17
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