Business Insurance QuoteHotel/Motel, Commercial, Garage & Repair Shop, EPLI, Restaurant/Bar, Commercial Property, Apartment Owners, Retail Store, Manufacturer Insurance General Information Contact Name * First Name Last Name Email * Phone Number * (###) ### #### Type of Business * Business Name Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Business Phone * (###) ### #### Current Insurance Coverages Current Insurance Company * Current Insurance Coverages * Bond Commercial Auto Commercial Liability Commercial Property Liquor Liability Directors & Officers Liability Disability Group Health Group Life Professional Liability Workers' Compensation Other Business Information # of Full-time Employees # of Part-time Employees How many years have you been in business? * How many locations? * Please give a brief description of your business and clientele: * Property/Premises Information Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Occupancy Status Owner Tenant Year Built % Occupied Sprinklers Yes No Construction Type * Frame Brick Veneer Stucco Metal Concrete Stories * # of Basements * Sq. Footage * Burglar Alarm * Yes No Building Value * Contents and Other Property (specify) Insurance Information Business Personal Property Amount * Annual Gross Sales: (before taxes) * Annualized Payroll * Cost of any Subcontracted Work * If Liquor Liability is required, Gross Annual Liquor Sales Liability Limits Requested * $300,000 $500,000 $1,000,000 $2,000,000 Describe any claims you've had in the past 5 years: * Additional Comments Thank you!