Business Insurance Questionnaire
CONFIDENTIAL - FOR QUOTING PURPOSES ONLY
Business name*
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Brief description of business operations
*
Contact Name and title
*
Phone Number
*
Email
*
example@example.com
Type of legal entity
Please Select
Sole Prop
Partnership
Corporation
LLC
Non Profit
Number of years in business
Number of owners/partners
Number of full-time/part-time employees
Any work subcontracted? If so, what percentage of business
Annual gross sales/Revenue
Annual payroll
Property and casualty insurance
General liability
Commercial auto
Commercial property
Professional liability (E&O)
Directors and officers liability
Business owners package policy (BOP)
Workers compensation
Commercial crime
Cyber Liability
Employee benefits
Group health insurance
Group life insurance
Group disability insurance
401K / retirement plans
Supplemental plans / AFLAC
Key man life insurance
Key man disability insurance
Key man disability insurance
Deferred compensation
Additional information, questions, or concerns
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