Business Insurance Questionnaire

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 *

Area Code Phone Number
Email *
example@example.com
Type of legal entity
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
Should be Empty:

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