Non Profit Application - The Advantage

TRAILER SECTION
Does The Organization Own A Trailer?
- Yes
- No
Year:
Make:
Model:
VIN #:
Is Anything Being Stored Inside The Trailer?
- Yes
- No
(If yes, please complete section below)
If Yes, Please Estimate Contents Value:

WORKERS COMPENSATION SECTION
Does The Organization Have Employees?
- Yes
- No
(If yes, please complete section below)
Total Number of Employees?
Number of Pay Periods:
- Bi-Weekly
- Bi-Monthly
- Annual
Workers
Employee Name
Full Time/Part Time
Job Title
Annual Payroll
(including auto & housing allowances if applicable)
(Complete This Section Only If your Organization Have Employees)

AGREEMENT SECTION
I understand that no coverage can be bound or modified by voice mail, email, and fax or online via the agency’s website and is not effective until confirmed directly with a licensed agent. This is not an offer of insurance.
Administrator Signature*
Print Name
Captcha

MINISTRY ADVANTAGE NON-PROFIT APPLICATION