Business Insurance Questionnaire
If you are looking to get a quote for your business please answer the questions below.
Email address *
1. Business Name *
2. Business mailing address *
3. Please enter your name *
4. Are you an authorized representative of this organization? *
5. Operating premise address *
6. Do you rent or own your operating premises? *
7. Select your entity designation? *
8. Please describe you business operations *
9. Business phone number *
10. Cell phone number (skip if same as business phone)
11. Enter your EIN # *
12. Enter the number of employees *
13. Enter the number of subcontractors
14. Enter your annual revenue (projected if open less than 1 year) *
15. Enter your total payroll expense (projected if open less than 1 year) *
16. Do you use any vehicles for your business operation? *
17. Are you required by contract to have a bond? *
18. Are you required by contract to have professional liability insurance? *
19. Are you required by contract to list an additional insured? (email a copy of the contract to *
20. Have you had insurance on this business in the past 3 years? *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of CIB Professional Services. Report Abuse