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# ______________
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.