Please fill out the form as completely as possible in order to get an accurate fitness insurance quote.
Would you prefer a paper application? Click here to download or print the application, you can then fill it out and fax it to us at: 509-484-6432 or email it to us at: stevenm@buckaffiliates.com

Your Name (required)

Your Email (required)

Phone Number (required)

Company Name (required)

Federal ID #

How many years In business?

Number of years experience

Do you rent or own your facility?
 Rent Own

Do you have subcontractors?
 Yes No

Current insurance company

Current policy number

Any insurance claims?
 Yes No

Annual total estimated receipts

Annual retail gross receipts

Annual membership gross receipts

Annual snack bar receipts

Annual video receipts

Annual tanning receipts

Number of tanning beds

Who controls the tanning bed timers?

Do you have swimming pools?
 Yes No

Do you have hot tubs?
 Yes No

Do you have child care?
 Yes No

Square footage of your facilities

Value of buildings

Value of all business property

# of employees

Website

Legal Structure

Landlord or bank info

Do you sublease space and to whom?

Martial arts classes

Mailing address:

Location Address(es)

Please UPLOAD, email or fax a copy of your waiver of liability you have your clients sign.
Once we receive these items we can start the process

After going over your application, one of our fitness insurance representatives will get back to you as soon as possible with a custom plan to best fit your needs.