Instructions:
Please fill out the form below to get an email with your quote of the top rated plan. Once you purchase, we immediately email you and the venue a certificate of insurance!
1. Special Event Information
Contact Name:
I am / We are a:
Name of Entity Type
What type of Event are you Holding ( example Wedding / Birthday party / Trade Show / Vendor ) :
What is the Title or Name of this Event:
Please describe your event to us in as much detail as possible. What will the event consist of?:
2. Special Events Date
Date this event will start:
Time this event will start:
 
Time this event will Ends:
 
Number of days the event will last:
How many such events do you expect to attend / hold in the next 12 months ?  
3. Contact Information
Address:
     
     
     
 
   
Email:
Phone Number:
4. Special Event Coverage
Need Coverage For :
Will there be any Live Music at the Event?
Yes No
Will you provide any Security?
Yes No
Will alcohol be served at the event?
Yes No
Have you bought Insurance from us Before?
Yes No
Cost of admission per attendee:
Total attendees or spectators:
Daily Participants / Organizers:
5. Venue Details (Location Where Event Will take Place)
Venue Name:
Address:



   
Will the Event be held?
Indoor Outdoor Partially Outdoor
Vendors/Exhibitors needed to be covered under your policy?
Number of Exhibitors:
Yes No
Number of Vendors:
How Did You Find Us:   
Are you a robot?


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Copyright 2005-2015 Jeewanjee Insurance Agency All rights reserved
California Lic # 0697055
1494 Hamilton Ave #101, San Jose, CA 95125