List Employee's
Annual Payroll Here (if none, enter $0):
$
Insert #
of Employees here:
Location & Sales
Information:
Insert Annual
Gross Revenues from this operation here:
$
Square Footage
of office or business location:
Type of Building
(wood frame, concrete, etc.):
Number of
Stories:
Are there other
business/residences in this building (describe)?:
Describe safety
features (alarm, sprinklers, fire protection, etc):
Coverage Desired:
(Check One Please)
The
Coverage I Am Looking For:
Liability Only Liability & Business Contents Liability,
Building & Contents Coverage A Package Policy Including the
Above, Plus
Miscellaneous Coverages
NOTE: Don't worry if
you are not exactly sure about coverage type... we will
suggest the best coverage for you - just try to tell us what
you are looking for! (If we need more info. we will let you
know.)
Business Contents Coverage: (The amount of your personal business property)
$
Building Coverage: (The amount
of building coverage if you own your bldg.)
$
Miscellaneous Coverage: (List
any special coverage peculiar to your business, such as
Garagekeepers Legal, Loss of Earnings, Valuable Papers,
etc.)
$
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quotation via:
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