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Office and Business Owner Quote Request
Your Information
Last Name
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First Name
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Email Address
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Street Address
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City
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State
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Zip Code
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Phone Number
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Alternate Phone
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Business Information
Company Name
Company Street Address
City
State
Zip Code
What is the nature of your business? (Bar/Restaurant, Manufacturing, Retail, etc.)
(250 chars left)
Is the business a corporation, partnership, or sole proprietorship?
Corporation
Partnership
Sole Proprietorship
Number of owners
Number of owners
Payroll of Owners
Payroll of Employees
Total annual gross receipts
Business License Number
License Type
Years of experience
Years operated under current name
Other business names
Is this business open 24 hours a day?
Yes
No
Any deep frying (food)?
Yes
No
Is there any manufacturing, mixing, re-labeling or repackaging of products?
Yes
No
Is there filling of propane tanks?
Yes
No
Please describe the nature of your business and ANY unusual exposures:
(500 chars left)
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Building & Property Information
Building & Property Information
Total square footage of the building your business is in
What date was the property purchased?
Total square footage of the customer area only
How many stories is it?
If two stories, what is the ground floor square footage?
What is the construction type?
Frame
Brick
Stone
Masonry
Superior
Log Cabin
Frame-Stucco
Masonry Veneer
What type of roof covering?
Was the roof updated?
Yes
No
If yes, what year?
What is the distance to fire protection?
1000 ft or less to hydrant and 5 mi or less to fire station
Over 1000 ft to hydrant and 5 mi or less to fire station
Between 5 and miles to fire station
Over 10 miles to fire station
Is the business in a brush area?
Yes
No
Do you have a storage area more than 1500 sq. ft?
Yes
No
Are there smoke detectors at this location?
Yes
No
Is there a fire extinguisher?
Yes
No
Are there deadbolts on all doors?
Yes
No
Is the electrical updated?
Yes
No
Are there circuit breakers?
Yes
No
Is the heating / air conditioning thermostatically controlled?
Yes
No
Is the heating/ air conditioning central?
Has the plumbing been updated?
Yes
No
If yes, what year was the plumbing updated?
Does the building have interior automatic fire sprinklers?
Yes
No
Is there a theft alarm?
Yes
No
Is there a fire alarm?
Yes
No
Are there any restaurants in your building
Yes
No
Are there any restaurants in the building next to your business?
Yes
No
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Claim & Coverage Information
Claim Information
Were there any losses or claims in the last 5 years?
Yes
No
If yes, what is the date, amount paid and description of each loss or claim?
(500 chars left)
Coverage Information
Current Insurance Company
How much are you paying now?
What is the liability limit requested?
$100,000
$300,000
$500,000
$1,000,000
What is the building limit requested?
What is the building deductible requested?
$250
$500
$1000
$2500
What is the business personal property (contents) limit requested?
What is the contents deductible requested?
$250
$500
$1000
$2500
What is the loss of income requested?
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Questions or Comments
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Home
About
Articles
Resources
Products & Services
Life Insurance
Life Basices
Term Life
Permanent Life Ins
Term Life Glossary
Universal Life Quote
Whole Life Quote
Term Life Quote
Burial/Final Expense Quote
Health Insurance
Intro to Health Insurance
Implementing A Cafeteria Plan
Individual Health Quote
Employer Group Health Plan Quote
Group Health Employee
Health Savings Account
Travel Medical Insurance
Medicare Plans
Intro to Medicare
Medicare Advantage
Medicare Part A
Medicare Part B
Medicare Part D
Medigap Policies
Medicare Supplement Plan Quote
Long-Term Care
Intro to Long-Term Care
Understanding Long Term Care
Long Term Care Quote
Disability Coverage
Intro to Disability Ins
Disability Statistics
Disability News Source
Council for Disability Awareness
Social Security Program Fact Sheet
Disability Ins Quote
Homeowners
Homeowners Coverage
Homeowners Quote
Manufactured Home Quote
Homeowners Links
Contact Us
Auto Insurance
Intro to Auto Ins
Auto Ins Coverage
Kelley Blue Book
Edmunds.com
Auto Ins Quote
Add/Change a Vehicle/Driver
Recreational
Intro to Recreational Vehicle Ins
Travel Trailer Quote
Motor Home Quote
Snowmobile Ins Quote
Boat Ins Quote
Business Owners
Intro to Business Ins
Business Owners Quote
Financial Vision
Financial Planning
Estate Planning
Client Questionnaire
Tax Center
Federal Benefits
Life Settlements
Get a Quote
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