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Purchase Dance Studio Insurance

Instructions:
Please enter the information below to complete the application for the Dance Studio Accident Medical & Liability Insurance Program. Once you have entered the required information click the button below 'Continue to Payment' and you will be brought to the payment gateway. Please call Westpoint Insurance toll-free (800) 318-7709 if assistance is required with this form.

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Are you a new Customer?
Are you a current customer requesting a Renewal Policy?

x Rate

= Sub-Total (Minimum $450)

Optional Coverage

Hired and Non-Owned Automobile Liability

Information

Dishonesty Bond


Information


Contents/Sports Equipment/Inland Marine Coverage

Information
Select your coverage:

=Grand Total

(Includes $20 certificate license fee.)

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Are you a (choose one):*



Does your organization utilize a waiver system?
Does your organization have a risk management plan?
Does the property where you are conducting the activity require a Certificate of Insurance (additional insured)?



List additional insured name(s) and address(es)

   


   


   



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Premium is fully earned on the effective date of coverage. No pro-rata refunds will be made. Cancellation requests prior to the effective date must be in writing and subject to a minimum cancellation fee of $75.00. I understand and agree that (a) if this application is accepted by the Company, coverage will begin on the date of acceptance or the date requested in the application, whichever is later, subject to payment of the required premium; and (b) Premium computation is subject to audit. Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits application or files a claim containing a false or deceptive statement is guilty of insurance fraud.

Please check the box to verify and agree that the information provided herein is
true and complete.
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