Intake form

Help us serve you better

Name *

Email address *

Business name

Business location

Type of services offered

Please select at least one option.

Tattooing

Piercing

Tattoo Removal

Body Modification

Number of employees

Do you have any independent contractors?

What coverage options are you interested in?

Please select at least one option.

General Liability

Products & Completed Operations

Professional Liability

Communicable Disease Coverage

Assault & Battery Coverage

How did you hear about us?

Additional questions or comments

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Jason Insurance Services, LLC