US Windsurfing is not currently able to process Insurance online. Please print this application, make your insurance check payable to The David Agency and send 385 North York Road, Elmhurst, IL 60126. If you have any questions, please call 630-592-5314.
If this page does not include enough room for your needs, you may also submit this information is any format that meets your needs. We just need to get the item, year, make, model, serial number, amount of insurance & agreed valuation information for processing.
[Remember, you must be a current member of US Windsurfing to take advantage of this offer. ]
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| Name: | ||
| Address: | ||
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Fax: |
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| E-mail: |
The David Agency will inform you by e-mail when they have processed your information. |
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| US Windsurfing Sail number | ||
| Have you had any losses? |
yes - if yes, list on a separate piece of paper no |
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| Item | Year Built | Make & Model | Serial Number | Amount of Insurance & Agreed Valuation |
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| Total amount this page: | * | |||
| * Multiply the Total Amount of Insurance x 0.02 | Premium: | ** | ||
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**Issue your check for the premium amount you calculated or $100 (minimum premium) which ever is greater. Send check made payable to The David Agency and mail to: 385 North York Road, Elmhurst, IL 60126. If you have any questions, please call 630-592-5314 |
Check amount: | |||
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