Fillable COVER-PRO APPLICATION DOG GROOMER SUPPLEMENT ent twelve (12) (Philadelphia Insurance Companies)

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COVER-PRO APPLICATION DOG GROOMER SUPPLEMENT ent twelve (12) (Philadelphia Insurance Companies)

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COVER-PRO
SM
APPLICATION
DOG GROOMER SUPPLEMENT
1. Full name of the Applicant Firm:
2. Please provide a breakdown of the most rec
ent twelve (12) months gross receipts
:
Animal Percentage of Oper
ations
Dogs: %
Show Dogs: %
Cats: %
Others (specify): %
3. Do you have a Master Groomer certification from the NDGAA? Yes
No
ADD
ITIONAL INFORMATION
This section may be used to provide additional information to
any question on this ap
plication. Please
identify the question number to which you are referring.
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cov
e
r-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Must be Principal, Partner or O
fficer)
__________________________________________
Signature Date
PI-PLSP-DGSUPP 08/10
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COVER-PRO APPLICATION DOG GROOMER SUPPLEMENT ent twelve (12) (Philadelphia Insurance Companies)

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Completed 7 November 2020

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