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| Underwriting Information: |
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Describe IN DETAIL,
Your Business Operations: |
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| Ownership & Payroll Data: |
| List Employee's Annual Payroll Here (if none, enter $0): |
$
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Insert # of
Employees here: |
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| Location & Sales Information: |
| Insert Annual Gross Revenues from this operation here: |
$
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Square Footage of office or business location: |
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| Type of Building (wood frame, concrete, etc.): |
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Number of Stories: |
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| Are there other business/residences in this building (describe)?: |
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Describe safety features (alarm, sprinklers, fire protection, etc): |
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| 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
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| 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.) |
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Liability Coverage:
($300,000, $500,000, $1 Million, etc.) |
$
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Business Contents Coverage:
(The amount of your personal business property) |
$
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Building Coverage:
(The amount of building coverage if you own your bldg.) |
$
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Miscellaneous Coverage:
(List any special coverage peculiar to your business, such as Garagekeepers Legal, Loss of Earnings, Valuable Papers, etc.) |
$
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