Amusement / Inflatable Rental Application

Please Indicate Forms of Coverage Requested:

How You Operate Your Business

Please also attach the following items:

  • Current claim history report from current agent from the past five years (if applies) or send a signed and dated letter referencing your business name and state if there have been any report of injury from the date your business formed to the present date.
  • If you have operated without insurance or have gaps without insurance coverage, send a signed and dated letter with your business name referenced and state date business formed and if any report of injury from that date to present date.
  • Rental Agreement (must include hold harmless wording)

Any person who knowingly and with intent to defraud an insurance company or other person files an application for insurance or statement of claim containing materially false information or conceals information for the purpose of creating a false or misleading impression regarding any material fact has committed a fraudulent insurance act, which is a crime in many jurisdictions and may be subject to criminal prosecution, the payment of civil fines and imprisonment.