Christmas Tree Lot Insurance Questionnaire

Christmas Tree Farm Insurance Questionnaire
Applicant's Name:*
Address:*
Mailing Address
Address (cont):*
Mailing Address - continued
Contact:*
Email*
Telephone:*
Website
Fax:
Applicant is:

IndividualPartnershipCorporationOther (specify)Other
Current Carrier:
Expiration Date:
Limits: ($)
Premium: ($)
Deductible: ($)
Limit of Liability Desired:

$300,000$500,000$1,000,000
GENERAL INFORMATION
1. Number of Sales Locations (Please list address of each location if owned or leased. List additional locations on separate page.)
Location 1:
Location 1:

OwnLease
Location 2:
Location 2:

OwnLease
2. Are any of the locations a nursery or tree farm?

YesNo
2a. If yes, what is the total acreage owned or leased?
3. Are customers allowed to cut or trim trees?

YesNo
3a. If yes, tools provided to cut trees-check all that apply:

Hand SawsPower SawsHatchet or AxeOther
3a. Describe "Other"
4. Do you load trees on/in customer vehicles?

YesNo
5. Other Activities:
5a. Hay Rides

YesNo
5ai. If yes, describe:
5b. Sleigh Rides

YesNo
5bi. If yes, describe:
5c. Amusement Devices

YesNo
5ci. If yes, describe:
5d. Food Sales

YesNo
5di. If yes, describe:
5e. Check if applicable:

Sledding/Tubing HillIce SkatingSkiingPetting ZooCraft ShowOther
5e. Describe "Other"
6. What are anticipated gross sales?
7. Will you have a max capacity limit for the number of people allowed on the premises at one time?

YesNo
7a. If yes, what will this capacity be?
SIGNATURE
The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.
Signature
Or Enter Your Full Name as Signature:
Date:
Questions? 877-244-9090
Kevin Morency | kmorency@morencyinsurance.com

Morency & Associates Inc.
141 New Shackle Island Rd, Hendersonville, TN 37075
Fax: 615-452-6580

https://christmastreefarminsurance.com/
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Christmas Tree Farm Insurance Questionnaire