Please be as detailed as possible so that we can assist you with your insurance proposal ASAP! If we have any additional questions, we'll be in contact shortly!
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| Your Name | |
| Company Name | |
| Company Address | |
| Contact Phone Number | |
| Contact Email Address | |
| Date Your Business Started | |
| Description of Operations | |
| Location 1 - List Year Built, Square Feet, Construction Type, Owner or Tenant | |
| Location 1 - Business Property Limit | |
| Location 1 - Business Income Limit | |
| Location 2 - List Year Built, Square Feet, Construction Type, Owner or Tenant | |
| Location 2 - Business Property Limit | |
| Location 2 - Business Income Limit | |
| Total Scheduled Equipment Value | |
| Total Unscheduled Equipment Valule | |
| Estimated Annual Sales | |
| Break down % of sales (example: 50% water remed., 40% putback, 10% mold) | |
| What % of Sales is Commercial vs Residential? | |
| Provide the Year, Make, Model & Value for all Vehicles to be covered (VIN#'s if available) | |
| Would you like a Workers Compenation Quote as well? | |
| Do you have a current umbrella? If so, what is the limit? | |
| What date does your policy expire? | |
| Who is your current insurance carrier? | |
| Please provide a listing of any claims in the last 3-5 years | |
| Any other important details? | |
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