IDAL Insurance Application

For questions regarding this form, call 866-916-9420.

Applicant Information

Category:*   
Are you a current member of IDAL:*
Applicant Name:*
Legal Business Name:*
Address:*
City:*
State:*
Zip:*
Phone Number: (xxx) xxx-xxxx*
Email Address:*  

Insurance Information

1. Policy effective date:
2. Do you perform any work other than what is necessary and Incidental to Decorative Painting, Decorative Plastering, and Wall Stenciling?
3: Total Gross Sales (Revenue) projected for the next 12 months:
4. Do you require proof of insurance for all subcontracted employees? (1099 employees)
5: During the Past three years has any company ever cancelled, declined, or refused to renew similar coverage?
6. Any Claims in the last 3 Years?
7. Do you perform regular/straight painting (painting that is not considered decorative nor base coats to decorative finishes)?
8. Do you perform any exterior painting?

E-Signature

The applicant represents that the above statements and facts are true and that no material facts have been suppressed or misstated and further acknowledges that the answers provided herein are based on reasonable inquiry and/or investigation.

Completion of this form does not bind coverage. Applicant’s acceptance of the company’s quotation is required prior to binding coverage and policy issuance.

All written statements and materials furnished to the company in conjunction with this application are hereby incorporated by reference into this application and made a part hereof.

Applicant's Signature (type full name):*
Date:*

[X]

Our records indicate you have either entered the number in wrong or you don't have the correct membership level to apply for this insurance plan. To upgrade your membership and qualify for IDAL Insurance please visit this site: https://decorativeartisans.site-ym.com/general/register_member_type.asp

All fields are required.