GL/PROP Quote Form

GL/PROP Questionnaire Quote Form

Please fill the form accurately for better assistance
Name*

First NameLast Name
Business Name *
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Describe Business *
Describe Business in Detail

Name of Owner(s)*
List name
IndividualPartnershipCorporationOther
If Other, describe:
Describe Business in Detail
Year Business Established *
Years Experience in Field *
Hours of Operation *
Days of Operation *
Current Insurance and Coverage *
If any claims, how much was paid out?

- Number of Employees *
- Payroll per Employee *
- Commercial %*
- Residential %*
- Liquor % *
- Food % *

- Year Built *
- Percentage Occupied %*
- Sq Foot *
- Roof Type *
- Age of Roof*
- Age of Plumbing *
- Age of Electrical *
- Alarmed *

- General Liability $*
- Building $*
- Business Property $*
- Garage Liability $*
- Per Vehicle $___________Max Limit *
- Max Amount for all vehicles *
- Cargo (Truckers) $*
- Inland Marine $*
- Any tools over $1000 need to be Scheduled
- Should be Empty: