Transcription of Distributor/Wholesaler Supplemental Application
{{id}} {{{paragraph}}}
Example: stock market
Distributor/Wholesaler Supplemental Application
Carrier: A Berkshire Hathaway Company Distributor/Wholesaler Supplemental Application Complete in addition to Acord Applications NAME OF APPLICANT Location Address: Website Address: I. GENERAL INFORMATION. 1. Applicant operates as a: (check all that apply) q Wholesaler q Distributor q Retailer 2. Does the Applicant engage in any business operations at another location other than those disclosed on this Application ? If "Yes," explain: q Yes q No 3. Are there any other persons or organizations, subsidiaries, affiliates or other entities related to the Applicant (including DBAs) for which coverage is desired? q Yes q No If "Yes," please list and describe the relationship to the Applicant: Note: There is no coverage for any such person, organization or entities unless endorsed to the policy. The following questions relate to Applicant only. 4. How many years has Applicant operated under present ownership? 5. How many years has Applicant operated at the above location?
1 of 5 Carrier: A ershire athaa ompany Distributor/Wholesaler Supplemental Application Complete in addition to Acord Applications NAME OF APPLICANT
Tags:
Information
Domain:
Source:
Link to this page:
Please notify us if you found a problem with this document: