Church Insurance Application

Need more time to complete this form?
Download the PDF and return the completed application to
Wilma Miller – Morrow Insurance Group
18936 N. Dale Mabry Highway
Lutz, FL 33548
FAX: (813) 830-7870 E-Mail: wilma@integrityfirst.cc

Name of person completing this form *

Primary Contact Information

First Name *

Last Name *

Primary Phone Number *

Fax #

E-Mail Address *

Church Information

Church Name *

Church FEIN *

Street *

City *

State / Province *

ZIP / Postal Code *

Membership

Sanctuary Capacity

Weekly Services

Hold down the Ctrl Key to make multiple selections.

Describe Fund Raising Activities

Describe Youth Activities

Playground on Premises

Playground Boundary Restraint (Fence)

Playground Equipment Maintenance Program

Playground Ground Cover

Submission Validation

Required

Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.

Insurance Websites Designed and Hosted by Insurance Website Builder