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, 300 Mt. Lebanon Boulevard, Suite 225, Pittsburgh, PA 15234-1509 

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.