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On-Line Wedding Insurance Quote Form One Simple Form - takes only 2-3 Minutes! Your Personal Data
Your Name
Street Address:
City:
State: (Must be New York)
Zip/Postal:
E-Mail (REQUIRED):
Phone:
Fax: (Optional)

Event Details
Date(s) of Event:
Describe Event in DETAIL:
Event Location (address):

Number in attendance:

Will food be served?	Yes No
If yes to food, describe:

Will Alcochol be served?	Yes No
If yes to alcohol, describe:

Describe security at event:

Describe music if any, at event:

Is There a Charge to Get In (called a "cover charge")?	Yes No

If charge, estimate receipts:	$

Approximate square footage of location you are using:

Name and Address of Additional Insured, if any (usually the facility):

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All Choice Insurance Agency, Inc.
5 Astri Court _ Suffern, NY 10901
Phone: 845-357-9200 | Fax: 845-533-4020 | New York Ins. Lic#1134607
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