Update Dealer Policy

Consignee's Name:

Consignee's Street Address:

Consignee's City:

Consignee's State:

Consignee's ZIP Code:

Type of Inventory:

Coverage Amount:

Comments:

Desired Effective Date:

Bank Name:

Bank's Street Address:

Bank's City:

Bank's State:

Bank's ZIP Code:

Coverage Amount:

Comments:

Mailing Street:

Mailing City:

Mailing State:

Mailing ZIP Code:

Change Also Applies to the Premises Location:

YesNo

Comments:

Location Street:

Location City:

Location State:

Location ZIP Code:

Existing Policy Limit of Insurance:

Requested Policy Limit of Insurance:

Comments:

Central Station Alarm:

AddRemoveEmpaty

Calls alarm company or police (location away from premises which is continually monitored)

Safe:

AddRemoveEmpaty

Weighs at least 300 lbs. empty, no wheels, with a combination, digital or key lock.

Vault:

AddRemoveEmpaty

Has 3-inch walls, no windows and metal doors.

Location Street:

Location City:

Location State:

Location ZIP Code:

Comments:

Away from Premises:

WorldwideDomestic

Has 3-inch walls, no windows and metal doors.

Coverage Amount, Including Excess Coverage:

Reason for Being Away from the Premises:

Travel Date From:

Travel Date To:

Travel From Location:

Travel To Location:

Comments:

Coverage Amount, Including Excess Coverage:

Shipment Date:

Items Shipped:

Shipping Carrier:

Shipping Method:

City & State of Origin:

City & State of Destination:

Signature Required:

YesNo

Only Signature Required shipments will be eligible for Temporary Excess Coverage.

Comments:

Add/Remove Type of Inventory:

Add Type of InventoryRemove Type of Inventory

Type of Inventory:

Comments:

USPS Coverage:

Add CoverageRemove Coverage

$25,000 Limit for Signature Required Shipment (Registered or Express Mail) - Class 3; $2,000 Limit for Signature Required Shipment (Insured Mail, Certified Mail and Signature Confirmation Mail) - Class 5; $400 Limit for No Signature Required Shipment (Other Covered Mailings) - Class 6.

Comments:

Please note that no coverage will be bound and no changes made on any policy without a written "Confirmation of Insurance", Binder, Endorsement or Reinstatement from Collectibles Insurance Services. Coverage cannot be assumed if you do not receive one of the aforementioned notices.

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