Application for NMRA Insurance Program
Please print all information. Make checks payable to J. A. BASH &
COMPANY and mail with this completed application to:
J.A. Bash & Company,
Member Name
__________________________________________________________ NMRA# ______________
Address
__________________________________________________________
A. Blanket Coverage -
Maximum value under $200, 000 total and $5,000 per item
Limit $ _______________ x .0075 = $ __________ Blanket Coverage Premium
B. Inventory Coverage - Please submit schedule
Limit $ _______________ x .0060 = $ __________ Inventory Coverage
Premium
C. Layout Coverage (Excluding rolling stock)
*Limit $_______________ x .0060 = $ __________ Layout Coverage Premium
A+B+C ($100 minimum) $
_______________ + $10.00 NMRA Fee = $
______________ Total Premium and
NMRA Fee
Note: all premiums should be rounded to the nearest
dollar.
Premium savings may be available if you accept a
higher deductible or have an acceptable security system. Call or write for details.
Policy is effective upon receipt of application! payment and approval by Peerless Insurance.