|
QUOTE REQUEST - Contact Information |
| Organization Name: |
|
| |
|
|
First Name: |
|
|
Last Name: |
|
|
Address: |
|
|
City: |
|
|
State: |
|
|
Phone: |
|
|
Zip Code: |
|
|
E-mail: |
|
|
Confirm E-mail: |
|
| Website: |
|
|
Your Business Information |
| Gross
Receipts: |
Definition
New businesses may estimate their gross receipts,
but we need this information to obtain a quote. |
Annual Payroll
(if any): |
(or write none) |
| |
|
| Workers
Comp Quote?
|
|
| |
|
| Number of
Owners/Partners: |
|
| Number of
Employees: |
|
| Square feet of
your office or where you work? |
|
| |
|
Groomer
Equipment:
(NOT mounted to vehicle) |
How much groomer equipment (not mounted to your
vehicle) would you like on the
quote? |
| |
|
Groomer
Equipment:
( mounted to vehicle) |
How much groomer equipment (mounted to your
vehicle) would you like on the
quote? |
| |
|
| |
|
| Year Business
Started: |
|
| Mobile Groomer: |
|
| Home Business: |
|
| Kennel Business: |
|
| |
|
| Any Claims: |
|
| |
|
| When are you
looking to start a policy? |
|
| |
|
| |
|
|
Do you need you have any special requirements for
your grooming business?
(If you have a claim, tell us here) |
|
| |
|
| |
|
|
Types of
Insurance Requested: |
General
Liability Insurance (Business Owners Policy)
Pet
Groomers Professional Liability Insurance
Coverage
for Mobile Pet Groomer Equipment
Coverage
for
Animals in the Event of a Death (Animal Bailee)
Workers
Compensation
Cyber
Liability (Technology Risk)
Employment
Practice Liability (EPLI)
Directors
and Officers (D&O)
Crime
Insurance
Surety
Bonds |
| |
|
| |
Do you have any other information
about your business, or comments that you would like to
share? Please place special requests here. |
| |
|
| |
|
| |
|
|
|
| |
|
| |
|
| |
|
|
Someone will contact you about your insurance request to go over the
coverage and options usually in the same day.
NO COVERAGE IS BOUND,
OFFERED, ISSUED THROUGH THIS ELECTRONIC COMMUNICATION, ALL POLICIES MUST BE
UNDERWRITTEN AND APPROVED BY THE CARRIER. DO NOT CANCEL YOUR CURRENT
INSURANCE.
Groomer Insurance, General
Liability Insurance, Animal Groomer Professional Liability Insurance, Insurance
Copyright 2014 Stratum
Insurance Agency, LLC
|