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Submit the forms below to update your policy

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CIS Website: Dealer Policy Update

Dealers

Consignor’s Loss Payable

Lender’s Loss Payable

Mailing Address

Named Insured

Policy Limit of Insurance

Protective Safeguards

Scheduled Premises (Physical Location) Change

Temporary Additional Away from Premises Coverage

Temporary Additional Shipping/Mailing Coverage

Types of Inventory

USPS Mail Coverage

Other

First Name:(Required)

Last Name:(Required)

Business Name (if applicable):

Policy Number:(Required)

Phone:

Email:(Required)

Consignee's Name:(Required)

Consignee's Street Address:(Required)

Consignee's City:(Required)

Consignee's State:(Required)

Consignee's ZIP Code:(Required)

Coverage Amount:(Required)

Type of Inventory:(Required)

Comments:

Desired Effective Date:(Required)

MM slash DD slash YYYY

Bank Name:(Required)

Bank's Street Address:(Required)

Bank's City:(Required)

Bank's State:(Required)

Bank's ZIP Code:(Required)

Coverage Amount:(Required)

Comments:

Street:(Required)

City:(Required)

State:(Required)

ZIP Code:(Required)

Is this an additional location?(Required)

Yes

No

If No, please indicate which address this is replacing that is currently scheduled on your policy:

Address if "No" is selected

Type of Structure:(Required)

Type of Construction:(Required)

If Other*, please describe:

If Other*, please describe:

Year Built:(Required)

If built before 1950, enter the date the electrical, heating, plumbing, and roof was last updated:

Storage of Collectibles:

Any collectibles stored in an immobile safe weighing at least 300lbs empty?(Required)

Yes

No

Any collectibles stored in vault with 3-inch walls, no windows, and a metal door?(Required)

Yes

No

If Yes, What is the construction of the vault?

What type of lock does the safe and/or vault have?

Combinatio

Digital

Key

Who has access to the safe and/or vault?

Other Securities:

Central Station Alarm

Smoke Alarm(s)

Deadbolts

Bars

Other

If Other, please describe:

Describe where and how your collection is stored or displayed on your premises:(Required)

Are any of the collectibles stored in a basement or other areas below the ground floor?(Required)

Yes

No

If Yes, a Stillage Endorsement will be added to the policy requiring all items be stored 6″ off of the floor.

Are any of the collectibles stored outdoors exposed to the elements?(Required)

Yes

No

If Yes, please describe:

Comments:

New First Name:(Required)

New Last Name:(Required)

New Business Name (if applicable):

Reason for Name Change:(Required)

Location Street:(Required)

Location City:(Required)

Location State:(Required)

Location ZIP Code:(Required)

Existing Policy Limit of Insurance:

Requested Policy Limit of Insurance:

Comments:

Central Station Alarm:

Add

Remove

Calls alarm company or police (location away from premises which is continually monitored)

Safe:

Add

Remove

Weighs at least 300 lbs. empty, no wheels, with a combination, digital or key lock.

Vault:

Add

Remove

Has 3-inch walls, no windows and metal doors.

Location Street:(Required)

Location City:(Required)

Location State:(Required)

Location ZIP Code:

Comments:

Away from Premises:

Worldwide

Domestic

Coverage Amount, Including Excess Coverage:(Required)

Reason for Being Away from the Premises:(Required)

Travel Date From:(Required)

MM slash DD slash YYYY

Travel Date To:(Required)

MM slash DD slash YYYY

Travel From Location:(Required)

Travel To Location:(Required)

Comments:

Coverage Amount, Including Excess Coverage:(Required)

Shipment Date:(Required)

MM slash DD slash YYYY

Items Shipped:(Required)

Shipping Carrier:

Shipping Method:(Required)

City & State of Origin:(Required)

City & State of Destination:(Required)

Signature Required:

Yes

No

Only Signature Required shipments will be eligible for Temporary Excess Coverage.

Comments:

Add/Remove Type of Inventory:

Add Type of Inventory

Remove Type of Inventory

Type of Inventory:(Required)

Comments:

USPS Coverage:

Add Coverage

Remove Coverage

$25,000 Limit for Signature Required Shipment (Registered or Express Mail) – Class 3; $2,000 Limit for Signature Required Shipment (Insured Mail, Certified Mail and Signature Confirmation Mail) – Class 5; $400 Limit for No Signature Required Shipment (Other Covered Mailings) – Class 6.

Comments:

Description of Change:

Please note that no coverage will be bound and no changes made on any policy without a written “Confirmation of Insurance”, Binder, Endorsement or Reinstatement from Collectibles Insurance Services. Coverage cannot be assumed if you do not receive one of the aforementioned notices.

Name

This field is for validation purposes and should be left unchanged.

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