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Business Insurance Checklist
Business Insurance Checklist
General Information
Name:
*
Legal Name of Business:
Address
Street Address
City
State
Zip Code
Business Phone:
*
Email:
*
Insurance Needs
Choose Lines of Insurance You Are Interested In
Commercial Auto
Aviation
Business Interruption
Commercial Property
Commercial Liability
Contractor General Liability
Hotel/Motel
Liquor
Medical Malpractice
Office Pkg/Prof. Liability
Product Liability (E&O)
Restaurant
Special Events
Workers' Compensation
Other
Please Explain Other:
Current Insurance Information
Company Name (not agency):
Premium Amount:
Years Insured:
Policy Expiration Date
MM
DD
YYYY
About Your Business
Number of Employees:
Number of Locations:
Years in Business:
Annual Sales:
Detailed Description of Your Business:
Additional Comments or Questions
Email
This field is for validation purposes and should be left unchanged.
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