Business Questionnaire - New Quote
How did you hear about us? *
Business Name
Entity Type
Mailing Address
Physical Address
Phone Number
Email
FEIN *
Website
Detailed Description of Business
In what states does business operate in?
How many locations do you have?
What year did business start?
Have you had any losses in the last 4 years?
How many owners are in the business? What are their names? What is ownership breakdown?
How many employees do you have?
What is your payroll for employees and owners?
Do you use any subcontractors? If so, what are the costs for subs?
Estimated Gross Revenue
Building Info (year built, square footage, construction type, fire sprinklers, updates)
Property Values
Equipment Values
List of Vehicles
List of Drivers
Person Submitting This Quote *
Notes
Submit
Never submit passwords through Google Forms.
This form was created inside of Main Street Insurance Agency. Report Abuse