Information needed to quote Business Liability
Information needed to quote Business Liability
• Business Name: ___________________________________________________
• DBA: ____________________________________________________________
• Contact Person: ___________________________________________________
• Phone Number: ______________ E-Mail:_______________________
• Address: _________________________________________________________
• Website: _________________________________________________________
• Date Established: ______________ FEIN: ________________________
• Individual / Partnership / Corporation / LLC / Other: ___________________
• Current Liability Insurance in place: Yes / No
• If no, why not: ____________________________________________________
• Current Carrier: ________________ Expiration: ___________________
• Nature of Business: ____________________________________________________________________________________________________________________________________
• Describe Applicant’s experience in this type of business: ____________________________________________________________________________________________________________________________________
• Number of Employees: ___________ Annual Payroll: $______________
• Gross Annual Receipts / Revenue: $___________________________________
• Desired limits of liability: $1 million / $2 million / other: $________________
• Building Value: $____________ Business Property Value: $______________
• Building Sq. Footage: _______ Year Built: ____ # of Floors: _______
• Circle the following building features: Sprinkler System / Central Fire Alarm / Central Burglar Alarm
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