Business Insurance Quote

Name of Business
Address
City
State, Zip
Telephone No.
E-Mail
Webpage

Type of Entity		Individual
		Partnership
		Corporation
		LLC
		Joint Venture
		Other

Contact Person
Billing Address (if different from above)

Previous Carrier
Expiration Date	/
Number of Years in Business
Number of Claims (If any - past 5 years)
Type of Claim

Building Limit (if you own the building)
Deductible	--Please Select One--- $500 $1000

Business Personal Property Limit
Deductible	--Please Select One--- $500 $1000

Construction of Building		Frame
		Masonry
		Non Combustible
Is your building sprinklered?		Yes		No
Description of your Operations
Other Building Occupants
Do you lease your building to others?		Yes		No
Year of Construction
Square Footage
Number of Stories
Is there a basement?		Yes		No

Building Improvements

Year of Renovations:
Wiring
Roofing
Plumbing
Heating

Roof Type	--Please Select One-- Wood/Shingle/Rubber Metal Concrete
Liability Limits	--Please Select One-- $300,000 $500,000 $1,000,000

Hours of Opperations
Number of Employees
Approximate Payroll	$ .
Annual Sales	$ .

Alarm Type	--Please Select One-- Central Station Local None
Dead Bolts		Yes		No
Maximum Cash on Premises	$ .

If you are a tenant, are you required by your lease to insure your building glass?
			Yes		No
Value of your Sign		$ .
Building Owner (owners name or entitiy)
Mortgage		$ .
Address (city, state, and zip)