Getting Started with Business Insurance
Ready, Set GO!
When do you need coverage to start?
-
Month
-
Day
Year
Date
Who Referred you?
if you are an insurance agent, please type your name here :)
Business Owner Contact Information
Let's get to know you :)
Legal Name
*
First Name
Last Name
Date of Birth
*
Cell Phone #
*
-
Area Code
Phone Number
Email
*
example@example.com
What type of entity are you?
*
Please Select
Individual
LLC
Corporation
Trust
Legal Entity Name
What is your F-EIN number?
If none, please skip.
Business Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is your mailing the same as your business address?
*
YES
NO
What is the location of the business?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Tell Us About Your Business
Describe how your business makes money and/or it's purpose:
*
Business Website:
If you have a DBA, what is it?
What year did you start your business?
*
Is your business currently insured with an active policy?
*
Yes
No
No - New Business Venture
Does your business own any structures or buildings?
*
Yes
No
How much inventory does your business have?(products ready to sell)
*
How much does your inventory cost?
How much equipment/business property do you have?
*
If your business were to burn down, how much would all your business equipment or property cost to replace? i.e. laptops, desks, kitchen, tools, etc...
Do you have any W2 employees?
*
Yes
No
How many employees?
Please specify how many part time and how many full time
What is your monthly payroll?
What is your gross annual revenue?
*
If you're a start up, please PROJECT the annual revenue instead.
Provide any other details about your business you feel to be important for insurance:
Have you received any other quotes for this business yet?
*
Yes - (if so, please let us know)
No
Current Quotes
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Do you have any cars that are registered to the business?
*
YES
NO
Please provide all Driver's full name, date of birth and driver license # and state.
Please provide all vehicles' information.
Upload any insurance requirements you've been provided
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