AFFTA Member Insurance

Retail & Manufacturers Liability

If you are a operate a retail or manufacturing business, use this form.

This info will help us get you the appropriate insurance application(s) you will need to complete

"*" indicates required fields

Name*

First Last

Date of Birth*

Email Address*

Daytime Phone #*

Address*

Street Address Address Line 2 City ZIP / Postal Code

State*

Business Name

Hidden

State*

What type of business do you need liability insurance for?*

Type of Guide Services You Offer*

Quickly describe all of the different types of guiding services you intend to offer your clients.

Other Liability Insurance*

Let us know what other type of business you need liability insurance for.

Current Insurance Company*

Which insurance company is your current policy with? If this is a new business put "New business."

Policy Renewal Month*

Policy Renewal Year*

Hidden

Policy Renewal Date*

Month and year is all we require at this time.

How did you hear about Cross Current Insurance?*

Which one?*

Tell us how you heard about Cross Current*

Add your referrer's full name:*

As a thank you, your referrer will be added to our next quarterly drawing to win a cool prize!

Are you a member of an association?*

Which association?*

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Comments

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