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:
Insert Annual Gross
Revenues from Beer, Wine, and Liquor ONLY:
$
Describe sales of
other kinds from 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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