Business Insurance Questionnaire
Please provide as much information as you are comfortable with, so that we can get you the best possible quote to cover your business insurance requirements. Fill out this first par only for Liability.
Full Name *
Date of Birth
MM
/
DD
/
YYYY
Phone *
Email (Only to communicate about your quote) *
Business Name *
Business Address *
Please describe all the services offered by the business. You can also provide a website if you have one.
What year did you start the business?
Is the business set up as a Sole Proprietor, corporation, or LLC? *
If you are a Corporation or LLC please provide the name of the LLC or Corporation. If you are a Sole Proprietor and have a DBA please provide the DBA.
Are there any additional contact person(s) that need to be listed on the quote? (This would be anyone you wish to have access to make changes to the policy if needed such as a spouse or partner)
Are you interested in monthly payments or full payment for the year?
Clear selection
Do you currently have a policy in place for General Liability or Business Owner’s coverage?
Clear selection
If yes please provide the name of the current insurance provider and the date the policy renews.
Do any employees use their own vehicles for business purposes? If so you may want to include non-owned auto liability. This coverage extends the liability limit of the policy to the employee’s vehicle while they are driving for the business to cover in the event of an at-fault accident that leads to a claim against the business.
Typically the coverage limit applied to the liability limit is $1 million liability with $2 million Aggregate. Let me know if this coverage is adequate or if you need higher limits.
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