To complete application, print and complete the following
forms: (This application forms part of the policy.)
APPLICATION FORM - Print and complete Application Form below. (Preferred print font for this document is Times New Roman - 12)
INVENTORY FORMS - Complete Trophy Inventory Form(s) (click here for forms). Print form(s) and circle applicable limit of liability. Total limits of liability. (Values of trophies)
RATING POLICY FORM - Print and complete Rating Policy
Form (click here for form).
Total rating: multiply total limit of liability (value of trophies)
by rate. (Include off premises taxidermy cost, if chosen.)
RETURN entire Application Form, Inventory Form(s),
Rating Policy Form, and a premium check payable to
Lechner & Stauffer, Inc.
Attn: John R. Kauffman, CPCU., ARM., CPIA., CIC.
589 Main Street, PO Box 26, Pennsburg, PA 18073
(215) 679-9568 (800) 227-3907
Underwritten by Bankers Insurance Group
APPLICATION FORM
Are you a member of Safari Club International? (Please check) Yes_____ No_____
(If you are not a member, you can join.
Business Phone _________________ Home Phone ____________________
Location and Address of Covered Property:
Primary Residence
__________________________________________________________________
Secondary/Primary Residence
__________________________________________________________________
Business
__________________________________________________________________
Storage
__________________________________________________________________
How many years at current address? _____________________
Please list all property losses within the last three years at residence (primary and secondary) and business
___________________________________________________________________ ___________________________________________________________________
___________________________________________________________________
Effective date of coverage is 5 business days after your check and application have been received. The descriptions made in this application are for underwriting and rating purposes. For exact coverage information you must refer to your policy.
*NEW: Your policy can now cover your trophies while at a taxidermy studio in the United States.