Business Insurance Questionnaire
If you are looking to get a quote for your business please answer the questions below.
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Email *
1. Business Name *
2. Business mailing address including city, state and zip code *
3. Please enter your first and last name *
4. Are you an authorized representative of this organization? *
5. Operating premise address including city, state and zip code *
6. Do you rent or own your operating premises? *
7. Select your entity designation? *
8. Please describe your business operations *
9. Business phone number (xxx-xxx-xxxx) *
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 *
Do you have a copy of your subcontractors insurance policy listing you as the additional insured?
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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) *
Do you operate at multiple locations? *
List the addresses including zip code for each of your operating premises.
Do you have business personal property to insure? *
What is the total value of your business personal property? *
What is the square footage of your building or rented space? *
16. Do you use any vehicles for your business operation? *
Do your employees use their personal vehicle for your business operations? *
List VIN #, Year, Make and Model for all vehicles used in your business (this includes food carts and trailers)
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 *
Enter the Contracted Additional Insured contact info as listed on the contract.
Are you previously insured? *
List the insurance carrier name, policy # and effective date for your previous policy.
A copy of your responses will be emailed to the address you provided.
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