Welcome Back!

We hope your year was a success!

May we get current information for your renewal quote?

Please complete the form below

Thanks in advance!

Renewal Application

"*" indicates required fields

Step 1 of 6

Business Name (DBA)*

The Business Name (not the Formal Entity Name)

Your Name*

First Last

Co Owner Name (if any)

First Last

Type of Entity*

The type of formal business entity.

The Formal Entity Name*

(Full legal business name. Example Tattoo the Zoo, LLC)

Email*

Where you can receive sensitive information

Enter Email Confirm Email

Mobile Phone*

May we text you?*

Keeping you informed of the status of your Renewal, Service Requests, or Claims.

YES! Absolutely!

NO! Please, no.

Old School, no thanks!

Business Phone*

How would you describe your business?*

Traditional Tattooer, Tattoo Shop

Permanent Makeup Services and/or Training

Professional Piercing Studio

Beauty, Esthetician, Hair, Nails, Spa Etc

Independent Tattoo Artist

Independent Piercer

Tattooer, Conventions Only

Your Birthdate

So we can celebrate with you!

YYYY

FEIN

Not required, but we may need it in the future

Professional Association?

Member? We discount fees for all Association members, (must be verifiable).

Location Address*

If you don't lease a physical location or you're a traveling artist, please enter a home/mailing address.

Street Address City State Zipcode

Do you have multiple locations WITH a lease agreement?

IF SO, Please complete an application for EACH physical location you own or lease (NOT Booth or Room rentals)

YES

Mailing Address*

This is the address where you would like to receive mail.

Mailing Address is same as Business Address above

Street Address City State Zipcode

What is your current Business Location(s) Situation?*

I lease a space/studio. Lease is in my name

Booth, I pay a flat amount each month

1099, Commission Split

Room Share Agreement

I'm 100% booth rental with a flat fee

Health Dept. approved "At Home Studio"

I lease multiple studio locations

W2 Employee, I need my own insurance

I own the Building and Lease it to my Studio

I own the Building

Primary Services*

Check all that apply

I DO NOT offer these Primary Services

Traditional Tattooing

Piercing and Body Mods

Pigment Removal, Non Laser

Permanent Makeup using a machine

Microblading, NO Machine

Scalp Micropigmentation

Camouflage*

Microneedling, Microchanneling (ProCell)

Estimated Revenue for Primary Services*

Estimate revenue for the next 12 months. ONLY the ACTUAL cost of the Service. Do not include revenue from merch, jewelry, rent, or another source.

Offer Additional Services?*

Please select all services you currently offer or are considering in the future.

I DO NOT offer additional services

Lash Extensions or Tinting

Esthetician Work, Dermaplaning, Massage, Waxing

Traditional Makeup, Hair, FX Makeup, Nails

Injections, PRP, Fillers, Botox

Laser Technician

Electrolysis

Plasma / Fibroblast

Spray Tanning

Hyaluron Pen / Pressurized Injectables

Teeth Whitening

Medical Director

Estimated Revenue for Additional Services*

Revenue in the next 12 months. ONLY the ACTUAL cost of the Service. Do not include revenue from merch, jewelry, rent, or another source.

Do you sell Retail, Merch, Supplies?*

Yes

Estimated annual revenue from retail*

Do you Offer Training or Instruction?

Yes

I'm considering it

Types of Training or Instruction*

None of These

Fundamental PMU Training

Tattoo Apprenticeship

PMU Apprenticeship

Lash Extension Training

Bloodborne Pathogen Training

First Aid

Estimated Gross Revenue for Instruction Services

Business Property / Contents

Do you want coverage for contents at your Business Location?

Decor, Art, Furniture, Antiques, Reference Material, Merchandise and Retail Stock In the case of Fire, Vandalism, Theft?

YES, I lease a location and I want to cover my business contents

NO, I only want General and Professional Liability at this time

MAYBE, I am not sure, help

I understand and agree that I when I select "Liability Only" it is General and Professional Liability for my services, and NOT replacement coverage for my business contents, supplies, machines, income, papers and records etc.*

Yes, I agree

Do you own the building? Do you need coverage for it?*

Yes

What is the Current Insurable Value of the building?*

Have you made any "Tenant Improvements"?*

This includes the floors, lighting, moulding, cabinetry etc. Literally how you improved the space when you moved in, to make it "Yours". If there is a fire, we want to put it back the way it was...

Yes, I have made improvements

No, Decorated only, moved in "as is"

Total value of Tenant Improvements*

To Date, what is the cost of the Improvements YOU have made to your space? We want to put it back the way it was after a loss such as fire, smoke damage etc.

Do you need Tenant Glass Coverage?

If you are responsible for the glass breakage or damage, select yes. Glass is not automatically covered; it must be added.

Yes, I am responsible for damages

No, my landlord covers the cost if broken, or I do not need this coverage

Total value of Contents / Business Property*

How much money would you need to replace your Furniture, Art, Computers, iPads, supplies, stock, merch, appliances, etc? It's okay to overestimate here.

Business Income Coverage*

How much income would you need, EACH month for 3 months if your workspace was physically damaged and you could not work/generate an income?

Do you want Coverage for Equipment and Supplies taken "off site"?*

Conventions, Education, Guest Spotting, etc.

Yes

Value at any given time of Off-Site Equipment*

Square footage of your business or area*

Security features. (Check all that apply)*

Theft coverage may be included, but it is subject to a working central alarm system that's operational, notifies the 1st Responders and active at the time of loss.

None

Central Station Alarm (ADT etc)

Video System, Notifies the 1st Responders

Roll Down or Cage on Door & Windows

Smoke Detector

Fire Extinguisher

Deadbolts on all doors

Interior Fire Spinklers

Other

Name of Central Alarm Company

Is your location (building) older than 25 Years?*

NOTE - Special Form coverage may not be available if your property manager has not performed updates and inspections.

Yes

I don't know

Year Built*

Number of stories of the building*

Construction Type*

Roof Type*

Within 5 miles of a coastline or large body of water?*

NOTE! Wind and Storm Coverage may be Excluded for the Eastern Side of the States. Please apply for flood program coverage to cover your business operations and property!

Yes

Has there been any updates or inspections to the roof, HVAC, plumbing, or electrical?*

Please enter the Approx Year each was Updated OR Inspected below. Please ask the Property Manager or Landlord if you aren't sure, this information is Critical for Property Coverage.

Yes

I don't know

Roof*

Approximate Year

Plumbing*

Approximate Year

Electrical*

Approximate Year

HVAC*

Approximate Year

Do you offer beer or wine to your patrons?*

Yes

Do you comply with all City, County, Health and State Ordinances?*

This is a condition of our policy

Yes

Have you ever had a Health Department Violation?*

Yes

Stay current on Bloodborne Pathogen education?*

This is a condition of our policy

Yes

Do you obtain a signed release form for each client?*

This is a condition of our policy

Yes

How long do you keep signed forms on file?*

We encourage cyber safety precautions for digital release forms and privacy precautions with paper forms.

up to 1 Year

1-5 Years

5-10 years, I want them in case I get sued

Do you check, photocopy and keep on file the client's ID?*

Per your state and county health dept guidelines. This is mandatory in California.

Yes

Do you provide "After Care Info" after each procedure?*

This is a condition of our policy

Yes

Are you prepared to handle fainting or nauseated patrons?*

This is a condition of our policy

Yes

Are you 100% single use?*

Yes

Do you always use barriers and cord wraps?*

This is a condition of our policy

Yes

Add Sexual Abuse Misconduct Coverage for $200 per year?*

$200,000 Sub Limit

Yes

Add Assault and Battery Coverage for $200 per year?*

$100,000 Per Claim $200,000 Aggregate Limit

Yes

Add Communicable Disease Coverage for $150 per year?*

$100,000 Sub Limit

Yes

Add Cyber Liability / Data Breach Coverage for $50 per year?*

$25,000 Sub Limit

Yes

Raise the Professional Liability Limit to 1M for $350 per year?*

$1,000,000 Professional Liability Limit (from the included $500,000)

Yes

Do you want Terrorism coverage for a Minimum of $150 per year?*

Only certified acts are eligible for coverage through TRIA. A certified terrorism event is classified by the Secretary of the Treasury, Secretary of State, or the Attorney General.

YES

Do you manufacture, mix, blend, re-label, or repackage products to sell under your own name?*

Yes

Please describe the products you make or re-label*

Does staff use their own cars for bank / supply / food runs?*

Yes

Do you want coverage in case they have an accident in their vehicle?*

Business owners are responsible for damages if a crew member gets in an accident while running errands.

Yes

Have you had any claims or losses in the last 5 years?*

Yes

Please describe your claim and it's outcome

Comment Section

Anything you want us to know for your renewal offer;

Additional Document Uploader

Loss Runs, Other Company Quotes, Claim Documents, Additional Insured Requirements

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 10 MB.

The above information is accurate, true to my knowledge.*

I affirm and certify that all the information and answers to questions herein are complete, true, and correct to the best of my knowledge and belief. I understand that any misrepresentation, falsification, or omission of any facts called for in the application may render this application void and will be cause for cancellation, whenever discovered.

Yes

Consent*

Like most insurance agencies, we use use information from you and other sources, such as your driving and claims histories, insurance score, and other factors to calculate an accurate rate for your insurance, set you up for monthly payments (if chosen). New or updated information may be used to calculate your renewal premium.

I Agree

Name

This field is for validation purposes and should be left unchanged.

Renewal Center

Welcome Back!

We hope your year was a success!

May we get current information for your renewal quote?

Please complete the form below

Thanks in advance!

Renewal Application

Business Property / Contents

Contact Us

Follow Us

Get A Quote

Navigation

For Clients

Login

Renewal Center

Welcome Back! We hope your year was a success! May we get current information for your renewal quote? Please complete the form below Thanks in advance!

Renewal Application

Business Property / Contents

Contact Us

Follow Us

Get A Quote

Navigation

For Clients

Login

Welcome Back!

We hope your year was a success!

May we get current information for your renewal quote?

Please complete the form below

Thanks in advance!