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Please provide the following:
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If you are an insurance broker or agent please click here to submit an application.
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Name of Insured
Billing address
City
State
ZIP Code
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Contact Name
Phone
Email
Effective Date:
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Premises Addresses
If your entire collection is in one location please list it below.
If you have more than $25,000 worth of wine at a 2nd location (or a 3rd), please list those locations as well. We want to ensure that your entire collection is properly cared for.
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Location Address
City
County
State
ZIP Code
Date of Construction
Class of Construction
(ie. Wood frame, masonry, concrete or steel)
Number of Stories
Select the total value of wine in this location
(include itemized bottles)
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Location Address
City
County
State
ZIP Code
Date of Construction
Class of Construction
(ie. Wood frame, masonry, concrete or steel)
Number of Stories
Select the total value of wine in this location
(include itemized bottles)
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Location Address
City
County
State
ZIP Code
Date of Construction
Class of Construction
(ie. Wood frame, masonry, concrete or steel)
Number of Stories
Select the total value of wine in this location
(include itemized bottles)
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If your collection is valued at less that $500,000 and you have no single bottles valued over $1000,
we do not need an inventory. You are free to upload an excel or word document to this application but
are not required to do so. Should you have individual bottles valued at over $1000, please attach a
file to this application listing the size, vintage, wine and value of each of these bottles.
Upload your file (doc, xls, pdf)
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