COVER-PRO
SM
APPLICATION
TELECOMMUNICATIONS CONSULTANT SUPPLEMENT
1. Full name of the Applicant Firm:
2. What percentage of the Applicant’s g
ross annual revenue come
s from equipment sales? %
3. Does the Applicant work with established systems or are they customizing
clients’ curre
nt hardware and / or
systems? Yes No
4. Does the Applicant test the systems after installation? Yes No
5. Does the Applicant offer any guarantees? Yes No
6. Does the Applicant belong to any associations, societies or h
ave any accredia
tions? (Society of
Telecommunications Consultants, BICSI, TIA) Yes No If yes, please specify.
7. Does the Applicant participate in continuing education? Yes No
A
DDITION
AL 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 (Must be Principal, Partner or Officer
)
__________________________________________
Signature Date
PI-PLSP-TCSUPP 08/
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