Contact Information Applicant's Name * Is the property address the same as the mailing address? * No Yes Website Address http:// Phone * (###) ### #### Email Proposed Effective Date MM DD YYYY Applicant is: Individual Limited Liability Company Corporation Partnership Joint Venture Other (Specify) Classification of Risk Banquet Facility Bar/Tavern Bowling Center Bring Your Own Bottle Establishment Cabaret Comedy Club Deli Disco Fine Dining Gentlemen's/Strip Club Membership Club Night Club Restaurant Annual Gross Sales Liquor Sales Food Sales Gambling Other Number of Years in Business Opening and Closing Time Per Day Are there any catering services available No Yes Are facilities available for use or rent for private parties, receptions, banquets or similar affairs? No Yes Does applicant advertise or promote "happy hour" or other events when drinks are sold at a lower price than usual? No Yes Hookah exposure (communal smoking) No Yes Does application subscribe to a taxi or other service providing transportation home to apparently intoxicated persons? No Yes Thank you! Restaurant InsurancePlease enter as much details as you can to expedite your insurance needs.
