SOLAR CONTRACTOR APPLICATION

11-1-2001

1.  Insured_____________________________________________________________

2.  Address_____________________________________________________________

3.  City________________________ State______________ Zip__________________

4.  Phone No.______________________

5.  Date Business founded_______________________________________________

6.  No. of employees_______________

7.  Annual sales___________________ 8.  Annual payroll__________________

9.  Type of business:

              Retail      _______              Manufacturer  ______
              Wholesale   _______              Experimental  ______
              Distributor _______              Research      ______

10. Equipment installed:

    Swimming pool heaters  _____       Power generation equipment  _____
    Hot water systems      _____       Insulation                  _____
    Hot air systems        _____       Storm windows/doors         _____

11. Limit of liability required $_______________________________________

12. Deductible acceptable $_____________________________________________

13. Construction of building housing business___________________________
    ____________________________________________________________________

14. Amount of insurance required on building $__________________________

    Contents $_______________________  Furniture $______________________

    Stock    $_______________________  Tools, Equipment $_______________

15. Loss experience_____________________________________________________

16. Current carrier_____________________________________________________

17. Suggested rate or premiums__________________________________________

I ACKNOWLEDGE AND WARRANT THAT THE INFORMATION GIVEN IN THIS APPLICATION
EVEN IF NOT IN MY HANDWRITING, IS TRUE AND CORRECT TO THE BEST OF MY
KNOWLEDGE AND BELIEF.
SPECIAL NOTICE:  AS PART OF OUR UNDERWRITING PROCEDURE, A ROUTINE INQUIRY
AND/OR A CONSUMER CREDIT REPORT MAY BE MADE WHICH WILL PROVIDE APPLICABLE
INFORMATION CONCERNING CHARACTER, GENERAL REPUTATION, PERSONAL
CHARACTERISTICS, AND MODE OF LIVING.  UPON WRITTEN REQUEST, ADDITIONAL
INFORMATION AS TO THE NATURE AND SCOPE OF THE REPORT, IF ONE IS MADE, WILL
BE PROVIDED.

DATE__________   NSURED'S SIGNATURE________________________________________

SOCIAL SECURITY NUMBER __________________________________________________

THIS APPLICATION MUST BE FULLY COMPLETED, SIGNED AND DATED BY THE INSURED
OR IT WILL NOT BE ACCEPTED.

                                  AGENT...................................

                                  AGENCY..................................

                                  ADDRESS.................................

                                  CITY....................................

                                  STATE...................................

                                  ZIP.....................................

                                  PHONE...................................