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Gravity Certs
2024-10-24T16:28:12-04:00
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*
" indicates required fields
Types of Insurance Interests
General Liability
Directors and Officers
Employment Practices
Fiduciary Liability
Workplace Violence
Internet Liability
Name of Parent Organization
*
Primary Contact Name
*
First
Last
Primary Contact's Title
*
Phone
*
Contact Email
*
Website
SIC#
FEIN#
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
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California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Guam
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Indiana
Iowa
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Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Is the Applicant tax exempt under the US Internal Revenue Code?
*
Yes
No
Briefly describe nature of operations
*
Applicant Information
Number of Members
*
Please enter a number greater than or equal to
1
.
Number of Chapters
*
Please enter a number greater than or equal to
1
.
Does Applicant publish any magazines, periodicals, or newsletters?
*
Yes
No
Is Applicant involved in product research, product development, testing and/or certification?
*
Yes
No
Does Applicant set standards for the qualification and performance and/or certify its members?
*
Yes
No
Does Applicant engage in any disciplinary actions as a result of peer review activities?
*
Yes
No
Does Applicant administer or sponsor any insurance programs for its members?
*
Yes
No
Total Assets (Current Year)
*
Total Assets (Previous Year)
*
Net Assets / Funds Balance (Current Year)
*
Net Assets / Funds Balance (Previous Year)
*
Annual Revenue (Current Year)
*
Annual Previous (Current Year)
*
Net Revenue (Current Year)
*
Net Revenue (Previous Year)
*
Name
This field is for validation purposes and should be left unchanged.
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