COVER-PRO
SM
APPLICATION
MARKETING CONSULTANT SUPPLEMENT
1. Full name of the Applicant Firm:
2. Does the Applicant design, manufacture or test any product, or p
rocess for cre
ating a product? Yes No
3. Please indicate the percentage of the
Applicant’s gross ann
ual revenue from the last fiscal period involving:
Training & education: % New product / Service development: %
Attitude & opinion surveys: % Telemarketing / Sales: %
Competitive analysis: % Mailing list / Telemarketing list development: %
Customer service: % Research & Development: %
Marketing research: % EDP / MIS: %
Product testing: (specify industry) Competitive analysis: %
% Other:(specify) %
Other:(spec
ify) %
Other:(specify) %
TOTAL MUST EQUAL 100 %
4. Does the Applicant provide any services other than those services listed a
bove in question 3
? Yes No
If yes, please describe.
ADDITIONAL INFORMATION
This section may be used to provide additional information to
any question on this application. Please
identif
y the question number to which you are referring.
I understand that the information submitted herein becomes a part of my Philadelphia Insurance
Companie
s Cover-Pro
sm
application and is subject to the same conditions as stated on the application.
Name (Please Print) Title (Mus
t be Principal, Partner or Officer
)
__________________________________________
Signature Date
PI-PLSP-MKSUPP 08/10
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