By filling in the information below - we will be able to add covered items to your Jewelry Schedule. If you should have any questions regarding the completion of the form - you may call 513-868-9000 or email judy@wilksinsurance.com. Additionally please forward a copy of your appraisal or sales receipt by fax to 513.863-7277 or as a separate email attachment.

Insured Name:
 
Item Description:
Value:
 
Item Description:
Value:
 
Item Description:
Value:
 
Item Description:
Value:
 
Email Address:
 
 
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Last revised: April 27, 2005