Business QuotePlease enter as much details as you can to expedite your insurance needs. Basic Business Information Legal Business Name * DBA (Doing Business As) if applicable Years in Business * Gross Sales * # of Employees * Business Structure * Sole Proprietor LLC S-Corporation C-Corporation Business Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone Number * (###) ### #### Email * Business Description / Primary Services or Products * Ownership & Contact Details * First Name Last Name Phone * (###) ### #### Any High-risk activities? Heavy Machinery Flammable Materials Delivery Services Do you rent, own, or lease the business space? * Yes No Square footage of premises Industry / NAICS Code (if known) Liability Exposure Do you serve food/drinks? * Yes No Do you sell physical products? * Yes No Do you subcontract any services? * Yes No Do you host events or operate vehicles under the business name? * Yes No Line Insurance History Current Insurance Carrier (if any) Expiration Date of Current Policy MM DD YYYY Do you currently have Insurance? * Yes No Additional Coverage Options (Optional) Business interruption coverage needed? * Yes No Cyber liability? * Yes No Hired and non-owned auto coverage? * Yes No Employee dishonesty or crime coverage? * Yes No Thank you!
