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E-mail Questions to:


Toll-Free: 1-800-669-0040
Phone: 1-631-669-0365
Fax: 1-631-669-0158

Contact Address:
Norton & Siegel, Inc.
PO Box 220
Babylon, NY 11702

"Remember, All Our Policies Come With an Agent!"

On-Line Special Event
Insurance Quote Form
One Simple Form - takes only 2-3 Minutes!

Your Personal Data

Your Name
Street Address:
State: (Must be New York)
Fax: (Optional)
Event Details
Date(s) of Event:
Describe Event in DETAIL:
Event Location (address):
Number in attendance:
Will food be served? Yes No
If yes to food, describe:
Any Celebrities in attendance? Yes No
If yes to celebrities, describe:
Will Alcochol be served? Yes No
If yes to alcohol, describe:
Describe security at event:
Describe music if any, at event:
Is There a Charge to Get In
(called a "cover charge")?
Yes No
If charge, estimate receipts: $
Approximate square footage
of location you are using:
Name and Address of
Additional Insured, if any
(usually the facility):
Send my Quotation Results via: Fax E-Mail
Regular Mail
Please Call Me!

Thank you for filling out this form COMPLETELY!

We deem your data submitted as PRIVATE information. Every step has been taken to insure your privacy, security, and to release this information only to you. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release them from any liability should this information be accidentally viewed by others. Also, the insurance carriers reserve the right to issue coverage or not, and we cannot guarantee acceptance of a risk until approved by the company. ALSO NOTE: Because of the nature of special event policies, they are NOT CANCELLABLE AND NOT REFUNDABLE. If an event is delayed due to something outside your control such as a snowstorm, most times we can get the insurance changed to your new date.

Yes, I Agree. Please Rush my Event Quote

Click Button Below When Done

Please Click Only Once . . . May take up to 30 seconds!

Norton & Siegel, Inc. | PO Box 220 | Babylon, NY 11702 | Phone: 1-631-669-0365 | Fax: 1-631-669-0158
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