Pacific Hospitality Program Proposal Request

 

Personal Information
Name: Position
Facility Name: Phone:
Address
City State Zip
Facility Information
# of Locations:
# Rooms at ALL Locations:
# Employees at ALL Locations:
Policy Information
Policy Carrier Premium Expiration Date
Workers' Comp
Commercial Package
Commercial Umbrella
Insurance Agency:
Insurance Agent:
Agency's Phone:
Miscellaneous
Are you presently a CH&LA member?
Comments

 

 

Association Services and Insurance Brokers, LLC
9171 Towne Centre Drive, Suite 200
San Diego, CA 92122
(800) 420-4678   (858) 597-0830 Fax


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