VALUABLE ARTICLES PURCHASE FORM

PERSONAL INSURANCE

LEGACY PROGRAM

GROUP EXCESS

OTHER COVERAGES

VALUABLE ARTICLES PURCHASE
FORM

AUTO PURCHASE NOTIFICATION
FORM

TIP OF THE MONTH

WHO WE ARE

BWD ASSURANCES NEWSLETTER

To notify us of the purchase of a valuable article, please complete the information below. The article is not covered until you have been notified by BWD that your coverage has become effective.

* Required Fields


Insured Information
First Name	*
Last Name	*
Address	*
City	*
State	*
Zip	*
Email	*
Phone
Fax


Personal Article Information
Location	*
Item Number	*
Property Class	*
Description	*
Serial Number	*
Purchase/Appraisal Date	*
Value of Item	*
Is it contained in a vault?	Yes No

"Multiple Series Limited Liability Company"