Name Address

City State ZIP Website address

Email address Business Phone Number

Cell Phone Number

How would you prefer to be contacted? E-Mail Business Phone Cell Phone

Operate as Partnership Corp. Individual

What is your season of operation? Number of sites

Hookups

Do you have a Dump Station? Yes No

Do you have a Camp Store? Yes No

Do you have Security? Yes No

Do you have Fire Protection? Yes No

Do you have a Swimming Pool? Yes No

What are your daily fees?

This does not constitute insurance coverage being bound. This is only an information gathering form. Once the form is completed we will contact you for more information and to discuss your coverage request.