Business Insurance Step 1 of 7 14% Name Email Phone Business Name Business 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? Yes No Current Insurance Company Name How 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? Yes No How many claims 1 2 3+ Do you have a business location or a home office? Business Location Home Office Do you rent or own this location? Rent Own How 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? Yes No 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? Yes No Do you have company owned cars? Yes No Driver(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
