Business Insurance Step 1 of 7 14% NameEmail Phone Business NameBusiness Address Description of Operation(s)How many years are you in business under this name?How many years of experience do you have in this industry?Do you currently have business insurance?YesNoCurrent Insurance Company NameHow many years had you had insurance with this insurance company?Did you have any business insurance claims with ANY insurance companies within the last 3 years?YesNoHow many claims123+ Do you have a business location or a home office?Business LocationHome OfficeDo you rent or own this location?RentOwnHow much business equipment, tools, furniture do you have?How much business inventory/stock/materials do you have?What is the total estimated square footage of the location you occupy?What is your estimated annual sales? (Please estimate if new venture)Do you have any employees?YesNo What is the total estimated annual payroll?Total number of employees working for you?Total ## of Males# of Females List of Employee Positions, Descriptions of Duties, # of Employees in this position, payroll per employeeEmployee PositionsDescriptions of Duties# of Employees in this positionpayroll per employee Do you/employee(s) deliver to your customers?YesNoDo you have company owned cars?YesNoDriver(s) InformationFull NameDriver License #Issuing StateDate of Birth# of Accidents last 5 years# of Moving ViolationsDate of Defensive Driving Course Completion Vehicle(s) InformationVIN # of CarCar used for?Which driver drives? When do you need the insurance to start?MMDDYYYY Additional Notes/Information
