(Salon, Barber Shop, Hair Stylist, Esthetician, Nail Technician, Manicurist, Massage Therapist, Cosmetologist, Tanning Salon, Beauty School, Barber School, Cosmetology School, Booth Rental, Independent Contractor)
Please answer all of the following questions:
OPTIONAL PROPERTY COVERAGES
COMMERCIAL AUTOMOBILE INSURANCE
WORKERS' COMPENSATION INSURANCE
STOP GAP LIABILITY (Ohio Only) *Note: A signed Ohio Fraud Statement is required for applications.
I have read the above questions and I hereby declare to the best of my knowledge and belief that all of the foregoing statements are true and that these statements are offered as an inducement to the company to issue the policy for which I am applying.NOTICE: PLEASE READ BEFORE SIGNING!In order to underwrite the insurance applied for above, an investigation consumer report may be requested and made, including information as to the character of the applicant for insurance and the persons to be insured under the policy applied for, their general reputations, business characteristics and credit standing. You are advised that you may make a request within a reasonable time after receipt of this Notice for a disclosure by West Bend Mutual Insurance Company of the natureand scope of the investigation requested.Fraud WarningKentucky: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act which is a crime.Ohio: Any person who, with intent to defraud or knowing that he/she is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.All Other States: Any person who knowingly conceals or provides materially false, incomplete, or misleading information on an application or concerning a claim to an insurance company for the purpose and intent of defrauding the company, may be guilty of insurance fraud in violation of state law. Penalties may includeimprisonment, fines, or denial of insurance benefits.
Questions? 877-244-9090Kevin Morency | email@example.com Morency & Associates Inc., 1194 Long Hollow Pike, Gallatin, TN 37066Fax: 615-452-6580https://spasaloninsurance.com/