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APPLICANT INFORMATION

First Name:	Phone:	Ext:
Last Name:	Cell:
Insured Company:	Fax:
I am applying as an Individual, not under a company name.
Address 1:	E-Mail:
Address 2:	Confirm E-Mail:
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City:	Website:
State:	Postal Code:
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Note: Please use physical address as we cannot accept P.O.Box numbers.

Electronic Signature Disclosure and Consent Statement

What is an Electronic Signature?

An electronic signature is a process by which an insured signs their application via the Web. Submitting an electronic signature eliminates the need to print and mail your application and expedites the quoting process.

How does the electronic signature process work?

You will submit your electronic signature by reviewing your application and checking box(es) and/or typing specified text where indicated. Each signature is a one-time event and will only be used to sign your application or bind request. If you decide not to submit your application or bind request with an electronic signature, please contact us and you will be provided with an alternative method of submitting the application.

Can I obtain a paper copy of my submitted application?

Yes, you can log in to the TotalEvent® website to view and print your submitted application, or you can contact us to request that a copy of your submitted application be sent to you.

Electronic Signature Disclosure and Consent Statement

You consent and agree that your use of a key pad, mouse or other device to select an item, button, icon, checkbox, to enter text, or to perform a similar act/action, while using the TotalEvent® website, for the purpose of accessing or making any transactions regarding any agreement, acknowledgment, consent, terms, disclosures or conditions, constitutes your signature, acceptance and agreement as if actually signed by you in writing. You further acknowledge and agree that the taking of any such actions by you evidence your intent to sign any such agreement, acknowledgment, consent, terms, disclosures or conditions. You also agree that no certification authority or other third party verification is necessary to the validity of your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or any resulting contract.

Print Electronic Signature Information

I have read, understood, and accept the Electronic Signature Disclosure and Consent statement.

Insurance Coverage Application / Bind Request Format

I want to submit the completed insurance application using a secure electronic signature.

I want to download application as a PDF file. I understand that I must sign and return the application before a quote for coverage can be provided to me.

Liability coverage through TotalEvent® provides protection for third party bodily injury and property damage that could arise out of one of your client's events. Even if the venue does not require them to obtain this coverage to hold the event, it is an inexpensive way to protect your client against potential losses arising from their negligent acts or even defending against frivolous suit(s) brought against all involved parties. Contact us at [email protected] to learn more or to obtain a quote.

Just because your client is not required to obtain liability insurance they are not free from potential liability losses.
Learn More