IMPORTANT NOTICE

1. This special event insurance quote request applies only to the states of Oregon and Washington. Do not fill out this form if this event is not happening in Oregon or Washington.

2. No insurance will be started by submitting this form. Coverage may be placed in force only after you decide to purchase it from us, and then after you complete the insurance application and pay the initial premium.

3. Submitting the following quote request constitutes your agreement with the above statements. We will contact you within two business days after we receive your request. If you have questions concerning this notice or about the following form, please call us at 503-620-0230 or 1-888-620-0230.

Special Event Insurance Quote
  1. Your First Name
    Invalid Input
  2. Your Last Name
    Invalid Input
  3. Name to be insured, if different
    Invalid Input
  4. Street Address
    Invalid Input
  5. City
    Invalid Input
  6. State
    Invalid Input
  7. Zip Code
    Invalid Input
  8. Mailing address if different
    Invalid Input
  9. Phone Number
    Invalid Input
  10. Email Address
    Invalid Input
  11. Event website address, if any
    Invalid Input
  12. How many days is your event?
    Invalid Input
  13. What day does the event start?
    Invalid Input
  14. Time the event starts
    Invalid Input
  15. Date the event ends
    Invalid Input
  16. Time the event ends
    Invalid Input
  17. Describe the purpose of the event
    Invalid Input
  18. Describe specific details of event
    Invalid Input
  19. Facility Name
    Invalid Input
  20. Facility Contact Name
    Invalid Input
  21. Facility Contact Email
    Invalid Input
  22. Facility Street Address
    Invalid Input
  23. Facility City
    Invalid Input
  24. Facility State
    Invalid Input
  25. Facility Zip Code
    Invalid Input
  26. Facility Phone Number
    Invalid Input
  27. Facility Capacity
    Invalid Input
  28. How many people will attend your event?
    Invalid Input
  29. What type of seating will you have?
    Invalid Input
  30. Is the event indoors or outdoors?
    Invalid Input
  31. Will there be camping or overnight sleeping?
    Invalid Input
  32. Will admission be charged?
    Invalid Input
  33. If 'Yes', how much will you charge?
    Invalid Input
  34. What type of security will you have?
    Invalid Input
  35. How many security people will you have?
    Invalid Input
  36. Will security personnel carry weapons?
    Invalid Input
  37. Will liquor be served?
    Invalid Input
  38. Will liquor be sold?
    Invalid Input
  39. Names of additional insureds
    Invalid Input
  40. Have you ever held this event before?
    Invalid Input
  41. Name of prior insuring company
    Invalid Input
  42. What premium did you pay?
    Invalid Input
  43. Did you have any previous claims?
    Invalid Input
  44. Additional information or comments. If prior claims, describe them.
    Invalid Input
  45. Re-type the Security Field numbers in the box.
  46. Security Field
    Security Field The Security code you typed did not match. Please click "Refresh" and try again.
  47. To keep a copy of this form, please Print before Submitting
  48.   

Network with BTIA

Follow us on Twitter & Facebook:
BTIA on Facebook  BTIA on Twitter
Share this page with your network:
AddThis Social Bookmark Button

Questions?

If you have questions concerning this information, please call us at 503-620-0230, or come in.

Llámenos ya al 503-620-0230.