120 Broadway Amityville, NY 11701
631-841-0270
eeaton@eatoninsurance.com
Fax- (631) 841-0509
Eaton Insurance
Insurance For You & Your Business
Home
About Us
Business
Photography Insurance
Insurance Services
Claims
Contact
MENU
CLOSE
back
Special Events
You are here:
Home
Insurance Form
Special Events
Application Form
Please complete this form and we will contact you with a quote
Personal Information:
Last Name *
First Name *
Street Address *
City *
State *
Zip *
Email *
Phone *
Event Information:
Describe Events *
Date(s) of Event*
Event Location *
Number of Attendee's *
Will Alcohol be served?
Yes
No
If Yes, will there be hired bar tenders?
Will Food be served?
Yes
No
If Yes, is there a caterer?
Describe music, if any.
Name and Address of
Additional Insured, if any
Liability Limit
--- Select ---
1,000,000
2,000,000
Excess Liability Limit if needed
Captcha
98 −
= 97
Copyright 2014 Eaton Insurance Agency. Powered & Designed by
Design ME
|
Privacy