Laurence Cole Insurance Agency
P.O. Box 600183 Dallas, Texas 75360
6060 NCX Suite 232 Dallas, Texas 75206
PHONE: (214) 823-2653 (COLE)
FAX: (214) 823-3805
E-mail us: boxingins@aol.com
SPECIAL EVENT GENERAL LIABILITY
INSURANCE APPLICATION
DBA
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Name
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Mailing Address
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Zip
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State
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City
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Fax
Phone
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Date of Event
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Location
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Coverage limits requested
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Estimated attendance of event
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Date Premium was Sent & How? (1-1-01/FedEx)
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Attach a list any additional insureds, with address