Update your collector policy Submit the forms below to update your policy For additional support, please call us at 888-837-9537 to talk with an agent. CIS Website: An update to collector policy Collectors(Required) Automatic Monthly Increase Mailing Address Named Insured Policy Limit of Insurance Protective Safeguards Scheduled Items Scheduled Premises (Physical Location) Change Form Temporary Additional Away from Premises Coverage Temporary Additional Shipping/Mailing Coverage Types of Collectibles Other First Name:(Required)Last Name:(Required)Business Name (if applicable):Policy Number:(Required)Phone:(Required)Email:(Required) Automatic Monthly Increase:(Required) Add Remove This is an optional coverage for new acquisitions and appreciation of your existing collection. Adding this coverage will apply an automatic monthly increase of 1% in coverage, up to a maximum of $1 million.Comments:Mailing Street:(Required)Mailing City:(Required)Mailing State:(Required)—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingMailing ZIP Code:(Required)Change Also Applies to the Premises Location:(Required) Yes No 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 selectedType of Structure:(Required)ApartmentOfficeBankPublic StorageOther*Type of Construction:(Required)FrameMasonryThird SteelOther*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? Combination 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)—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLocation ZIP Code:(Required)Existing Policy Limit of Insurance:(Required)Requested Policy Limit of Insurance:(Required)Change is the result of adding or removing scheduled items: Yes No If Yes, please also complete the Schedule Items form.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)—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLocation ZIP Code:Comments:Add/Remove Item #1 (Valued $25,000 or More): Add Item Remove Item Item 1:(Required)Item #1 Value:(Required)Add/Remove Item #2: Add Item Remove Item Item 2:Item #2 Value:Add/Remove Item #3: Add Item Remove Item Item 3:Item #3 Value:Change will affect my current policy limit of insurance:(Required) Yes No If Yes, please also complete the Policy Limit of Insurance form. Comments:Where the collection is actually stored (a physical address is required, no PO Boxes).Location City:(Required)Location Street:(Required)Location State:(Required)—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingLocation 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 selectedType of Structure:(Required)—Single FamilyCondoApartmentOfficeBankPublic StorageOther*Type of Construction:(Required)—FrameMasonrySteelOther*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? Combination 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:Away from Premises:(Required) 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:Shipping Carrier:Select a CarrierFedExUPSDHLUSPSShipping Method:(Required)—PriorityOvernight2nd DayGroundRegisteredExpressCity & State of Origin:(Required)City & State of Destination:(Required)Signature Required:(Required) Yes No Only Signature Required shipments will be eligible for Temporary Excess Coverage. Comments:Add/Remove Type of Collectible:(Required) Add Type of Collectible Remove Type of Collectible Type of Collectible:(Required)Change will affect my current policy limit of insurance:(Required) Yes No If Yes, please also complete the Policy Limit of Insurance form. 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.NameThis field is for validation purposes and should be left unchanged. Δ
