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Back to Express Requests

Special Event 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
Date(s) of Event

If one day event, end date should be the same as start date. Quote will contemplate coverage for events continuing past 12:00 AM.

Desired Coverage Date(s)

Attach copy of brochure, website pages and flyer to this application or include details on all activities taking place.

Include name of performers and type of act

Liquor Liability (if coverage is desired)
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.

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Wholesale & Specialty Insurance Association Independent Insurance Agents of Oklahoma Oklahoma Surplus Lines Association USA Alliance