Home > My Music Business > Musical Instruments > Insurance Quote for Musical Instruments Insurance Quote for Musical Instruments The information requested on this form will allow us to request a premium indication from multiple insurance carriers on your behalf. Should you choose to accept one of these quotes, a formal application with your signature will need to be completed. Your Name* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is your home address the same as the mailing address?Yes / Not applicableNo, it is differentHome Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you keep instruments at a business address?YesNoBusiness Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*FaxEmail* Full Legal Name of BusinessIf different than your name.Business EntityLLCSole ProprietorPartnershipCorporationDBAFederal ID NumberDate your current business entity started If you don't know the exact day, use the 1st of the month in the proper year.Date quote is needed by? Do you have a current instrument insurance policy?YesNoCurrent Insurance InformationCurrent Instrument Insurance CarrierCurrent Instrument Insurance PremiumExpiration Date of Current Policy Have you had any losses or claims regarding any instrument in the last 5 years?YesNoIf yes, please give a description of the loss, the date of the loss, the amount paid and whether the claim is now open or closed.*Instrument InformationFor businesses or individuals with a large instrument schedule, please upload additional lists (see below) as needed or call our office at 800‐942‐5818 and speak to a music insurance specialist.Add Individual InstrumentsInstrumentValue ($)Serial NumberDescriptionPurchase Date Upload an Instrument List / ScheduleAccepted file types: pdf, doc, xls, csv, xlsx, docx, txt, jpg, gif.
