Applicant Information

Fields marked with an asterisk (*) are required.

Business Name
*

Note: This is the name that will appear on your Certificate of Insurance. If your company is a Sole Proprietorship, then this will be your personal name or DBA.

Contact Information
*
*
*
*

This is the email address we will use for contacting you about all insurance matters. Brokers, enter your email address.
*


Mailing Address
*
*

*
If your business has a location in New York, Washington or New Hampshire, your application will have to be reviewed by the insurance office.
*
Is this Mailing Address also a Studio Location where classes will be held?   *
Classes taught in a home are not covered.  
Studio Location(s)

Would you like to enter additional Studio Locations where classes will be held?   *  

Insurance Broker Use To be recognized as an insurance broker and eligible for a commission you must be an approved broker with our company and you must answer Yes to the following question and supply the other broker information requested. If you are not approved, you must contact us before applying for coverage.

Are you an Insurance Broker?