Laurence Cole Insurance Agency
P.O. Box 600183 Dallas, Texas 75360
6060 NCX Suite 232 Dallas, Texas 75206
PHONE: (214) 823-2653 (COLE)
FAX: (214) 823-3805
E-mail us: boxingins@aol.com
SPECIAL EVENT GENERAL LIABILITY
INSURANCE APPLICATION
DBA
Name
Mailing Address
Zip
State
City
Fax
Phone
Date of Event
Location
Coverage limits requested
Estimated attendance of event
Date Premium was Sent & How? (1-1-01/FedEx)
Attach a list any additional insureds, with address