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Back to Express Requests

Concessionaire / Vendor Express Request

*Complete and submit the form below for an Express Premium Indication from OGA’s Small Business Unit

Fax: 405.840.9388 | 800.771.8116
Phone: 405.840.9393 | 800.299.1951

Agency Information
Applicant Information

Include 3 year loss history

$

Collectables or Memorabilia, “Home Made” Products, Hearing Aids, Optical Goods (Prescription), Used or Refurbished Products, Hobby or Craft, Goods Manufactured by applicant, Products Sold Under own Brand or Label, Goods Packaged or Prepackaged by Applicant, Any Products Directly Imported by Applicant, Toys or dolls, Products Directly Imported by the Applicant.

Ammunition, Firearms or Weapons, Fireworks, Cars or Vehicles, Massage products, Fire or security alarm or device, Goods Rented to Others, Flying or Aerial Objects, Medical Supplies

Acupressure or Massage Services, Rock Climbing Walls, Contracting or Construction, Athletic Clubs or Activities, Tattoo or Body Piercing, Bathroom Attendants, Games of Chance, Transportation Services, Ice Cream Trucks (Mobile), Farms, Coat Check, Mechanical Rides

Inland Marine Section

If bound, scheduled property requires description of each item, year, manufacturer, model serial number and limit of insurance for each item.

$ Trailer/Cart
$ Contents
$

$2,500 maximum per item

Please Note

*Fully completed Acord applications and any applicable supplemental questionnaires are required prior to binding. Please note that the premium indication is subject to change upon receipt of the Acord and any required supplemental.

If needed, please include any comments or additional information here.