Business Quote

Please fill out this form completely to receive your quote:

Personal Information

* Required Field
* Name:
Business name:
Street address:
Zip code:
* Email address:
Phone number:
Fax number:

Underwriting Information

Nature of your business:
Type of business:
How many owners?
How many employees?
Payroll amount of owners?
Payroll amount of employees?
Total annual gross:
Business license number:
Years of experience in this business:
Years under current business name:
Have you used other
business names?
Are you open 24
hours a day?
Any deep frying (food)?
Is there manufacturing,
mixing, relabeling,
or repackaging
of products?
Is there filling of propane tanks?
Describe ANY unusual
exposures your business may have:

Building & Property Info

What is the total
square footage of
the building your
business is in?
What is the total
square footage of
your business only?
What is the square
footage of the
customer area only?
How many stories is it?
If it's two stories,
what is the ground
floor square footage?
What is the construction type?
What type roof covering?
If roof was updated,
what year?
What is the distance
of fire protection?
Is the business in a brush area?
Do you have a
storage area more
than 1500 Sq. Ft.?
Are there smoke
detectors at this location?
Are there fire extinguishers?
Are there deadbolts
on all doors?
Are there circuit breakers?
Is the electrical updated?
Is the heating/ air conditioning
thermostatically controlled?
Is the heating/ air
conditioning central?
Has the plumbing
been updated?
If yes, what year was
the plumbing updated?
Does the building
have interior automatic
fire sprinklers?
Is there a theft alarm?
Is there a fire alarm?
Are there any
restaurants in
your building?
Are there any
restaurants in
the building next
to your business?
Claims Information  
Where there any
losses or claims
in the last 5 years?
If yes, what is
the date, amount
paid and description
of each loss or claim?

Coverage Information

What is the
current insurance
How much are you paying now?
What is the liability
limit requested?
What is the building
limit requested?
What is the building
deductible requested?
What is the business
personal property
(contents) limit requested?
What is the contents
deductible requested?
What is the loss
of income requested?
Are there any
questions, comments
or additional
coverage required?
Please let us know
the best time to
call and discuss your quote.
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