Business Quote Name* First Last Email*Phone number*Name of BusinessDBA?NoYesDBABusiness Formation TypeLLCC- CorporationS- CorporationPartnershipSole ProprietorWhen did you start your business? Date Format: MM slash DD slash YYYY Length of Time in IndustryNature/ Description of BusinessPlease describe the business typeAdditional Information that might be helpfulBusiness Mailing Address* Street Address City ZIP Code Business Physical Address (if different)* Street Address City ZIP Code Number of Full Time EmployeesNumber of Part Time EmployeesGross 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? Date Format: MM slash DD slash YYYY How many years with your current insurance company?Any Claims in the past 5 years?NoYesClaim Date, Description of Claim, and $ Amount PaidCoverages Interested in: General Liability Property - Building Property - Business Personal Property Workers Compensation Commercial Auto Umbrella Key Person - Life Insurance Business Interruption