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Certificate of Insurance Request Form

Use this form only if you need to have your school or organization added as an additional insured on our policy.
(CLICK HERE if you would rather print and fax to Kalmanson Insurance)
 
** CLICK HERE if you just need a copy of our insurance policy. **
 
FORM WILL BE SENT TO:
Lester Kalmanson Agency, Inc.
PO Box 940008
Maitland, FL 32794-0008
Ph: (407) 645-5000
Fx: (407) 645-2810
TODAY'S DATE:
YOUR NAME:
YOUR E-MAIL:
YOUR PHONE:
SCHOOL/VENUE NAME:
SCHOOL/VENUE ADDRESS:
SCHOOL/VENUE CITY:
SCHOOL/VENUE STATE:
SCHOOL/VENUE ZIP:
SCHOOL/VENUE PHONE:
SCHOOL/VENUE FAX:
NEED CERTIFICATE BY:
DATE OF EVENT:
NUMBER OF SHOWS PER DATE:
SPECIAL REQUIREMENTS:
 
 
 
 
As seen at...
The GO BIG STUNT SHOW is perfect for your next school assembly
Over 5,000 shows performed
since 1996
 
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Wheels of Freestyle, Inc.
6191 Rancho Mission Rd. #107
San Diego, CA 92108
Toll-Free: 1-888-818-8388
  
Wheels of Freestyle, Inc.
6191 Rancho Mission Rd. #107
San Diego, CA 92108
Toll-Free: 1-888-818-8388 | Local: 619-284-0639 | Fax: 619-584-2023

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