Business Quote Name of Business DBA?NoYesDBA Business Formation TypeLLCC- CorporationS- CorporationPartnershipSole ProprietorDo you have a FEIN (aka Federal Tax ID)? No Yes FEIN Number When did you start your business? MM slash DD slash YYYY Owner Name* First Last Date of Birth MM slash DD slash YYYY Email* Phone number* Length of Time in Industry Nature/ Description of Business Please describe the business typeAdditional Information (List Autos to insure here or other drivers)Business Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business - Physical Address same as Mailing?YesNoBusiness Physical Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Number of Full Time Employees (include owner) Number of Part Time Employees Gross Sales per year ($) (if this a new business, what are you projecting your gross $$ to be for the next 12 months?)Business Personal Property ($) (this is coverage for inventory, equipment, tools, supplies, computers, etc)Do you currently have insurance for your business?NoYesCurrent Insurance Company? When does your current policy expire? MM slash DD slash YYYY How many years with your current insurance company? Any Claims in the past 5 years? No Yes Claim Date, Description of Claim, and $ Amount Paid Coverages Interested in: General Liability Property - Building Property - Business Personal Property Workers Compensation Commercial Auto Umbrella Key Person - Life Insurance Business Interruption Δ