Clarion Associates, Inc.| Insurance Firm dedicated to Musicians

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Personal Information

First Name:* Please enter first name
Last Name:* Please enter last name
Email Address:* Please enter email address Please enter valid email address
Phone:*
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Are you the owner?*

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Are you the primary player?*

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If No, please provide the full name and date of birth of the primary user *

Full Name :

Date of Birth (Primary Player): (MM/dd/yyyy)
Customer Type:* Please select customer type
Date of Birth (MM/DD/YYYY) (Policyholder):*
I wish to authorize another individual on my policy:*

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Mailing Address

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Country Name:* Please select mailing country
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Location of Instrument(s) Start

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Desired Effective Date of Policy

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Total Insured Value:* Please enter Limit

If you are a California resident, please click on the following link for an important notice regarding the collection of Personal Information: California CCPA Notice.

Please tell us which best describes you, the user of the instrument(s) or equipment?*

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