Jewelry Insurance Quote Request

Business Name*

Include Legal Name, DBA's, and all operating names and subsidiaries to be covered

Entity Type*

FEIN*

Federal Employer Identification Number

Principal/Officer Name(s)*

Premises Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Location Type*

Other, please explain

Is any location directly next door vacant?

YesNo

Annual Sales for this Location*

Percentage of Revenue by Type*

	Percentage of Revenue
Retail
Service (repair/design, appraisal)
Wholesale
Manufacturing/processing
Refining
Gold Buying
Other

*Fields above must add up to 100%

Total

Must Total 100%

Employees*

	Full-time Employees	Part-time Employees	Owners
Number of Employees

Your most recent physical inventory was taken on: Date*, and your total owned inventory amount was $*, at your cost.

Breakdown of Inventory*

	Percentage of Inventory
Loose Diamonds
Watches, and watch movements of $5,000 or less in value
Watches, and watch movements of more than $5,000 in value
Other Jewelry, Jewels, Pearls, Semiprecious Stones, Bullion, Gold, Silver, Platinum, and other Precious Alloys and Metals - valued at $500 or more/unit
Other Jewelry, Jewels, Pearls, Semiprecious Stones, Bullion, Gold, Silver, Platinum, and other Precious Alloys and Metals - valued under $500/unit
Scrap Precious Alloys or Metals

*Fields above must add up to 100%

Total

Must Total 100%

In the last 12 months, the average daily amount of customer's property in your custody and control was $*, and the average daily amount of memorandum or consignment property in your custody and control was $*.

Do you handle pawn property?*

YesNo

Exact recent pawn inventory $Amount*, Date*
Exact previous pawn inventory $*, Date*
Maximum amount loaned and unpaid, plus accrued interest on pawn last 12 months?
$*

During the term of the policy, the maximum value of property on premises customarily
kept out of locked safes, vaults, or stock rooms when closed to business will
be $*. Note: this is not a limit of insurance. See the limits pages to request coverage limit for property left out when closed to business.

Is your premises protected by an operating burglar alarm system when closed to business?*

YesNo

Name of premises burglar alarm service company:

You've selected "No," please explain:

Security Cameras*

	Yes	No
Is your premises protected by an operating camera system?
Does it cover all areas of your premises, aside from restrooms?
Is it operating and recording 24 hours a day, every day?
Are back-up recordings stored off-site?
Are there cameras located on the exterior of the premises?

Do you know how your alarm signal is transmitted to the monitoring station?

YesNo

Signal Transmission Method (Select all that apply)

DACT/POTS Type

Phone Line CutPhone Line Seizure

Radio Type

One-wayTwo-way

Manufacturer: Type a label* Model Number: Type a label*

Areas Covered by Burglar Alarm Motion Detection:

	Yes	No
Areas Where Merchandise is Left Out of Safe/Vault
Alarm Control Panel
The Safe/Vault Area

Safe Information*

Do you require shipping coverage?*

YesNo

Property shipped at our risk (or previous insurer's) and/or under the deductible amount during the last 12 months:*

	Number of Packages per Week	Average Value per Package
USPS Registered Mail - OVER $100k per package ONLY
USPS Priority Mail Express - UNDER $25k per package ONLY
USPS Priority Mail Express - OVER $25K per package ONLY
FedEx (all values)
UPS (all values)
Other Carriers (all values)
Armored Car Service

Prior Insurance Carrier: Type a label*, Premium $ *,
Expiration Date: Date*

Contact Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.