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ABOUT THE OWNER / PRINCIPAL |
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Company Name:
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First Name:
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Last Name: |
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Address: |
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City: |
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State: |
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Phone: |
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| Zip Code: |
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E-mail: |
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Confirm E-mail: |
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ABOUT THE BUSINESS |
| Name
of Business: |
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| Type of Business: |
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| Description of Business: |
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Year Started: |
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Years experience in industry: |
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| Tax ID # |
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Gross Receipts: |
$
Definition
New businesses may estimate their gross receipts,
but we need this information to obtain a quote. |
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| Do you currently
have one of the following? |
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We ask this question because some,
not all, small business policies policies require you to have
insurance at your home if you do not have an office.
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Commercial General
Liability / Business Owners Policy |
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General Liability Limits: |
$
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Space Occupied (sq feet): |
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Building Security System? |
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Location: |
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PROPERTY INSURANCE
(added to the general liability quote) -
OPTIONAL |
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| Business personal property
and equipment? |
(office equipment, supplies, furniture) (we can quote
coverage for inventory and food spoilage based on your industry) |
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Year Building Built: |
(estimate is
acceptable) |
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Building Insurance? |
(optional and may include tenant improvement coverage, or for the building) |
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Do you currently have insurance (if
yes, with what carrier?
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Current Premium:
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| Prior Claims: |
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Do you have any other information
about your business, or comments that you would like to
share? Please place special requests here, such as extra coverage
for special items. |
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