Business Insurance Questionnaire
If you are looking to get a quote for your business please answer the questions below.
* Required
Email address
*
Your email
1. Business Name
*
Your answer
2. Business mailing address
*
Your answer
3. Please enter your name
*
Your answer
4. Are you an authorized representative of this organization?
*
Yes
No
5. Operating premise address
*
Your answer
6. Do you rent or own your operating premises?
*
Rent
Own
7. Select your entity designation?
*
LLC
Corp (S or C)
Partnership
Not-for-Profit organization
Other:
8. Please describe you business operations
*
Your answer
9. Business phone number
*
Your answer
10. Cell phone number (skip if same as business phone)
Your answer
11. Enter your EIN #
*
Your answer
12. Enter the number of employees
*
Your answer
13. Enter the number of subcontractors
Your answer
14. Enter your annual revenue (projected if open less than 1 year)
*
Your answer
15. Enter your total payroll expense (projected if open less than 1 year)
*
Your answer
16. Do you use any vehicles for your business operation?
*
Yes
No
17. Are you required by contract to have a bond?
*
Yes
No
Maybe
18. Are you required by contract to have professional liability insurance?
*
Yes
No
19. Are you required by contract to list an additional insured? (email a copy of the contract to
admin@cibproservices.net
)
*
Yes
No
20. Have you had insurance on this business in the past 3 years?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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