Request a Quote for Games of Skill

Request a free quote for games of skill insurance by filling out the form below. Protect yourself with comprehensive insurance that covers your exact needs at the lowest prices possible.

An asterisk (*) indicates a required field.

Legal business name/DBA*

Business Type*

Other Business Type*

Your Physical Address*

Street Address City State ZIP Code

Contact Name*

Contact Phone Number*

Contact Email*

Website

Start Date

End Date

Name of event/promotion*

Description of event/promotion*

What is the value of the available prize(s) to be insured?*

Please provide the full details of how prize(s) will be won*

Estimated number of participants/attempts*

Number of game pieces to be distributed (if applicable)

Witness Name*

Witness Age*

Witness Occupation*

Do you have any prior insurance claims/losses or pending incidents which could result in a future claim?*

I confirm no prior insurance claims/losses or pending incidents.

I have a prior insurance claim/loss or pending incident

Comments (provide official rules or link to rules if available)

DECLARATION FOR SUBMITTING

To the best of my knowledge and belief the information provided in this application, whether in my own hand or not, is true and I have not withheld any material facts. I understand that Non-disclosure or misrepresentation of a material fact will entitle the company to void the Insurance. I understand that submitting this Application does not bind me to complete the insurance but agree that should an insurance policy be issued, this Application and the statements made therein shall form basis of the insurance policy.

(By clicking “submit” below you are agreeing to the following statement)

Name

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