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  • CBL Insurance Request Form

  • Today's Date: *
    MM
    /
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    /
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  • Team Owner/GM Making Request: *
    First
    Last
     
  • Team Owner/GM Email: *
  • Team Owner/GM Cell Phone: *
    (###)
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    ###
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  • CBL Team Name: *
  • CBL Team Location: *
  • Facility Information
  • Name of Contact at the Facility: *
    First
    Last
     
  • Email of Contact at the Facility: *
  • Phone Number of Contact at Facility: *
    (###)
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    ###
    -
    ####
     
  • Name of Faciltiy to be Insured: *
  • Address of Facility to be Insured: *
    Street Address
    Address Line 2
    City
    State / Province / Region
    Zip / Postal Code
    Country
     
  • What type of insurance are you requesting? *
    Insurance request must be submitted 15 business days prior to your event/game. If your insurance request is submitted after the specified time frame you will be required to pay rush order fees.
  • Thank you for submitting your information!