General Insurance Application Form
General Information

Name of Insured: (Legal Name)
Doing Business As:
Location Address:
Street:
City:
State:
ZIP:
Mailing Address:
(if different from above)
Street:
City:
State:
ZIP:
Contact Information:
Contact name:
Title:
Phone: -
Fax: -
E-mail:
Web Site:
How did you learn about The Monument Sports Group?:USIndoor web site
GOAL Indoor
Friend
Search engine (Google, Yahoo!, etc.)
Other:
Desired Coverage: General Liability
Participant Legal Liability
Participant Accident/Excess Medical
Property
Other:
Requested
Effective Date:		 (MM/DD/YYYY)
Requested
Termination Date:		 (MM/DD/YYYY)


Organization Information

Insured is:Corporation
Partnership
Other:
Type of Organization:Athletic Association
Club
League
Team
Other:
Type of Sport:
Years in business:
Total Annual Gross Receipts:$
Annual Number of Participants: Youth
Adult
Any activities
at an off-site location:		Yes   No   
If Yes, please explain:
Nature of Operation/Description of Event(s): (e.g. indoor multi-sport facility for indoor soccer, basketball, and volleyball practices and games)


Past Insurance Information

Have you had
any claims/losses
in past 5 years?		Yes   No   
If Yes, please explain:
Has your coverage ever been cancelled or non-renewed?Yes   No   
If Yes, please explain:


List all Sponsored & Supervised activities of the named insured including socials, fundraisers, fieldtrips, and others:



The Monument Sports Group manages your insurance needs so that you can concentrate on growing your business.
Copyright © Monument Sports Group, 2003