Please fill out the form as completely as possible in order to get an accurate fitness insurance quote.
Would you prefer a paper application? Click here to download or print the application, you can then fill it out and fax it to us at: 509-418-5048 or email it to us at: stevenm@buckaffiliates.com

    Your Name (required)

    Your Email (required)

    Phone Number (required)

    Company Name (required)

    Federal ID #

    How many years In business?

    Number of years experience

    Do you rent or own your facility?
    RentOwn

    Do you have subcontractors?
    YesNo

    Current insurance company

    Current policy number

    Any insurance claims?
    YesNo

    Annual total estimated receipts

    Annual retail gross receipts

    Annual membership gross receipts

    Annual snack bar receipts

    Annual video receipts

    Annual tanning receipts

    Number of tanning beds

    Who controls the tanning bed timers?

    Do you have swimming pools?
    YesNo

    Do you have hot tubs?
    YesNo

    Do you have child care?
    YesNo

    Square footage of your facilities

    Value of buildings

    Value of all business property

    # of employees

    Website

    Legal Structure

    Landlord or bank info

    Do you sublease space and to whom?

    Martial arts classes

    Mailing address:

    Location Address(es)

    Please UPLOAD, email or fax a copy of your waiver of liability you have your clients sign.
    Once we receive these items we can start the process

    After going over your application, one of our fitness insurance representatives will get back to you as soon as possible with a custom plan to best fit your needs.