Independent Fitness Trainer Liability Insurance Application
Applicant Information
Full Name
Date of Birth
Address
Phone Number
Email
Business Information
Business Name
Years of Experience
Certifications
Types of Services Offered
Training Locations
Coverage Information
Desired Coverage Amount
$500,000
$1,000,000
$2,000,000
Prior Insurance Carrier
Any Previous Claims?
No
Yes
If yes, please provide details
Declarations & Agreement
I confirm the above information is accurate and complete.
Signature
Date