Specialty Insurance Agency and Vendors Of The U.S.
   

This Application is for:

Policy Period :
 September 01, 2009 to September 01, 2010 With Product Coverage: $350.00
Reduced Premium:
 March 01, 2010 to September 01, 2010 With Product Coverage: $280.00
Note: This reduced premium option will be processed the last week of February.
Reduced Premium:
 June 01, 2010 to September 01, 2010 With Product Coverage: $200.00
Note: This reduced premium option will be processed the last week of May.
Option:
 Single Event coverage - $125.00 (Limited to 7 Consecutive days)
 Dates of event:
 
  • Fill in the information below.
  • Print out the application & mail with your check.
  • Make your check or money order made payable to Vendors of the U.S.
  • Mail to:  Specialty Insurance Agency
  • P.O. Box 24
  • New Richmond , WI 54017-0024
   

Application Form:

  
 
Business Name:
Business Owners Name:
Referred By:
Mailing Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Fax:
Email Address:
Description of what you sell:
   
Business Owners Signature:                                                                                  
Date:                           
   
Please Note:

Coverage is not available if you are selling: firearms, fireworks, swords, knives, infant products, medical products, nutritional products & supplements.

 
     
 
Website Design By: Noah Zenzen
Specialty Insurance Agency
Performers of the US & Vendors of the US
PO Box 24
New Richmond, WI 54017
Ph: 715.246.8908
Fax: 715-246-4257
steph@specialtyinsuranceagency.com