List
Employee's Annual Payroll Here (if none, enter
$0):
$
Insert # of Employees here:
Location
& Sales Information:
Insert Annual Gross Revenues from this
operation here:
$
Square Footage of office or business
location:
Type
of Building (wood frame, concrete, etc.):
Number of Stories:
Are
there other business/residences in this building
(describe)?:
Describe safety features (alarm,
sprinklers, fire protection, etc):
Coverage
Desired: (Check One Please)
The Coverage I Am
Looking For:
Liability Only Liability & Business
Contents Liability,
Building & Contents Coverage A Package
Policy Including the
Above, Plus
Miscellaneous Coverages
NOTE: Don't
worry if you are not exactly sure about coverage
type... we will suggest the best coverage for you
- just try to tell us what you are looking for!
(If we need more info. we will let you
know.)
Business Contents
Coverage: (The amount of your
personal business property)
$
Building Coverage: (The amount of building coverage if you
own your bldg.)
$
Miscellaneous Coverage: (List any special coverage peculiar to
your business, such as Garagekeepers Legal, Loss
of Earnings, Valuable Papers, etc.)
$
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