Business Quote Name* First Last Email* Phone number* Name of Business DBA?NoYesDBA Business Formation TypeLLCC- CorporationS- CorporationPartnershipSole ProprietorWhen did you start your business? MM slash DD slash YYYY Length of Time in Industry Nature/ Description of Business Please 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 Employees 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