Your Information

Step 1 of 5
Business Name:
Applicant Name:
Are you a broker?:
Agency Name:
Agency Address:
Agency City/State/Zip:
Agency Email:
Agency Phone:
Insured phone:
Insured Email:
Mailing Address:
City/State/Zip:
Business Address Same As Above?
Business Address:
City/State/Zip:
Operating as:
Working as:
Number of locations:
Do you operate a retail business grossing over $10,000?
Do you have insurance for it?
Are you in compliance with all city, county, state ordinances and work in a business shop?
How long in the business of body piercing?
How long in the business of tattooing?
 
Have you had formal instruction in body piercing?
Have you had an apprenticeship in tattooing?
If no, how trained?
How many body piercing procedures have you performed in the past 12 months?
How many tattoo procedures have you performed in the past 12 months?
Total # of people to cover:
# Tattoo only:
# Piercing only:
# Tattoo and piercing:
How did you hear about us?
Coupon Code:
 
 

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