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Digital Outdoor Billboard Application
1.

 Please complete the information below and submit to us at Snyder Insurance to obtain an insurance quote for your digital outdoor sign:

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Job Title:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.

How many years have you been in business?
 

  • 50 characters left.
3.

Please describe your operations:
 

  • 50 characters left.
4.

What is your desired effective date of coverage?
 

  • 50 characters left.
5.

What are your gross annual sales?
 

  • 50 characters left.
6.

Have you had any policy/coverage declined, cancelled or non-renewed in the past 3 years?  If yes, for what reason?
Yes
No
  • Comment:

  • 500 characters left.
7.

Have you ever filed bankruptcy or reorganization?  If yes, what was the date?
Yes
No
  • Comment:

  • 500 characters left.
8.

Please list the address or address of where the billboard will be located:
 

  • 50 characters left.
9.

What is the year built, the height and the wind rating (MPH) of the billboard?
 

  • 50 characters left.
10.

What is the total value of the billboard AND structure (pole, etc.)?
 

  • 50 characters left.
11.

What deductible would you like?
 

  • 50 characters left.
12.

Is this billboard replacing an existing billboard?  If yes, has the structure been re-engineered to accommodate the new digital billboard?
Yes
No
  • Comment:

  • 500 characters left.
13.

Optional Coverage:  Do you want flood insurance?
Yes
No
  • Comment:

  • 500 characters left.
14.

Optional Coverage:  Do you want earthquake insurance?
Yes
No
  • Comment:

  • 500 characters left.
15.

Describe your inspection and maintenance program.  Indicate frequency and by whom performed.  Are records kept of inspections and maintenance work?
Yes
No
  • Comment:

  • 500 characters left.
16.

What allowances were made in the design of the sign for ice?
 

  • 50 characters left.
17.

Describe your lightning protection:
 

  • 50 characters left.