300 Spindrift Drive
Amherst, NY 14221
(800) 728-6362
(716) 633-3400








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Request Dance StudioInsurance Quote

We are pleased to offer you a quotation on your insurance. Please fill out the form below & click on the submit button. We will process your application and contact you with a detailed presentation.
Fields marked with a red * are Required. Please provide us with a working email address &/or phone number, so that we can contact you.

If you need assistance or wish to learn more about the program, call Joanne Klenk at 1 (800) 728-6362.

Name*:

E-mail Address*:

Studio Name*:

Website Address:

Studio Address*:

Address Line 2:

City*:

State*:

Zip*:

County*:

Business Phone*:

Fax:

Business is:*
Corporation
Sole Proprietor
LLC
Partnership
Other
Coverage Start Date:


Add to our E-mail address book
for future newsletters that pertain
to insurance interest?


Years in Business*:

Do You Own the Building?*

Studio Building Insurance Value:

Approximate Age of Building:

Studio Building Construction Type*:

Personal Property Value (Studio Contents):

Property Deductible:

Number of Stories*:

Approximate Studio Square Footage (Length x Width):

Is There a Basement?*

Describe Other Building Occupants*:

Is The Building Sprinklered?*

Does Building Have Fire Alarms?*

Does Building Have Burglar Alarms?*

Average Number of Students per Year:*

Estimated Gross Receipts per Year*:

Do You Have Employees?*

Is a Worker's Compensation Policy In Force?*

Number of Independent Contractors Used*:

Describe Styles of Dance/Arts Taught*:

Do You Secure Waivers With Your Applications?*

Do You Carry Glass Coverage?

Do You Carry an Accident Policy for Students?

Does Your Current Policy Cover Abuse or Molestation?

Do You Carry an Umbrella Policy?

Current Liability &/or Property Insurance Company*:

Current Liability &/or Property Limit:

Current Liability &/or Property Insurance Policy Expiration Date:

Current Liability &/or Property Insurance Policy Premium:

Member of Dance Educators of America?

How Did You Hear About Us?


Claim Information
In order to properly underwrite and to keep the program
profitable for the membership, please complete the following
information for any claims reported in the past five years:

Has a claim been made in the last 5 years?*

If Yes, briefly describe claim including Date of Loss.
Claim 1:

Claim 2:


I hereby certify that to the best of my knowledge
and belief the information provided is true and correct
and that information which could materially affect this
insurance has not been withheld.

Enter security code here:

By filling out this form, it in no way represents binding insurance coverage.
This application is used to quote your insurance only.
We may not provide insurance in your state and we will advise you in an e-mail if you do not qualify.
Any information that you provide to Scott Danahy Naylon is private and kept confidential.
Please refer to the Legal page for full details.


 
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