ADDRESS OF LICENSEE:
(Shall not be less than $250,000 single limit/$500,000 aggregate limit)
After submission of this form, we will be contacting you for confirmation and payment.
Executed under the seal this ___________________ day of _____________ 2015.
LICENSOR: FAN PIER DEVELOPMENT, LLC
By (Name, Title): ____________________________________
I've read and agree to the terms and conditions.
© 2017 • Email or call us for more information • 617.443.9200 • email@example.com • VHF Channel 9