COVER-PRO
SM
APPLICATION
PRINTER SUPPLEMENT
1. Full name of the Applicant Firm:
2. Please indicate the percentages of the Applica
nt’s
total operations involving:
Business & legal forms: % Directories: %
Newspapers & magazines: % Catalogs: %
Pamphlets & flyers: % Corporate financials
(annual reports):
%
Discount & rebate coupons: % Social Printing (invitations, etc…): %
Lottery tickets: % Bindery: %
Contest / Sweepstakes tickets: % Other: %
Books: % TOTAL MUS
T EQUAL
100 %
3. Does the Applicant’s activities involve lettershop / mailing service
s (i.e. envelo
pe stuffing, postage handling,
mailing, etc…) Yes No If yes, please attach a written contract.
4. Does the Applicant’s activities involve the distribution and/or
redemption of coupons, rebates or promotional
game materials? Yes No If yes, please provide specific details and attach any applicable
contract(s).
5. Does the Applicant’s services involve the design of logos or trademarks? Yes No If
yes, please a
dvise
the following:
5a. Number of trademarks developed last year:
5b. Description of the Applicant’s legal review or oth
e
r
procedures used for clearing trademarks/copyrights:
6. Does the Applicant require its clients to approve proof copies before printing? Yes No
If yes, is approval in writing?
Yes
No
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
Officer)
__________________________________________
Signature Date
PI-PLSP-PTSUPP 08/
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