Business Onboarding Form
Monday.com Title
First Name
*
Last Name
*
Full Name
Policy
Email
*
example@example.com
Your Birthdate
*
-
Month
-
Day
Year
Date
Your Driver's License Number
*
Phone Number
*
Please enter a valid phone number.
Legal Business Name *Include Inc. or LLC if needed. (If you don't have a business name type "N/A")
*
What Year Was The Business Started?
*
Desired Effective Date of Coverage to Begin
*
-
Month
-
Day
Year
Date
Do you have an FEIN number?
*
Yes
No
FEIN Number
*
Address of Business
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is the above address the same as your Billing Address?
*
Yes
No
Address
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you own or rent your space?
*
Own
Rent
Did you invest money into building out the space?
*
Yes
No
How much did you invest into the buildout?
*
Replacement Value of Building
*
Ex: $450,000
Value of Contents / Inventory
*
Ex: $35,000
What does your business do or sell? (Explain what goods or services your business sells or provides).
*
Ex: Coffee Shop
What are your total gross receipts for last year?
*
Ex: $85,000
What do you expect the total gross receipts to be for this year?
*
Ex: $123,000
Do you have business owned vehicles or trailers?
*
Yes
No
How many vehicles does your business own?
*
1
2
3
4
5
Please enter the Year, Make & Model, and VIN# for Vehicle 1
Ex: 2018 GMC Acadia - VIN# 123456789
Please enter the Year, Make & Model, and VIN# for Vehicle 2
Ex: 2018 GMC Acadia - VIN# 123456789
Please enter the Year, Make & Model, and VIN# for Vehicle 3
Ex: 2018 GMC Acadia - VIN# 123456789
Please enter the Year, Make & Model, and VIN# for Vehicle 4
Ex: 2018 GMC Acadia - VIN# 123456789
Please enter the Year, Make & Model, and VIN# for Vehicle 5
Ex: 2018 GMC Acadia - VIN# 123456789
If you have any additional driver's please list their Name, Date of Birth, and Driver's License Number.
Do you have W2 Employees?
*
Yes
No
What is the annual payroll for all employees?
*
Ex: $44,500
Does The Business Have Any Prior Claims?
*
Yes
No
Please Describe The Claim(s):
*
Do you want Umbrella Liability Coverage?
*
Yes
No
I'm Not Sure - Provide Me More Details When You Provide Me A Quote
How much Umbrella Coverage would you like?
*
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
Do you have Machinery, High Value Equipment, or Tools that leave your premises on a regular basis that exceed $2,500 in value per item?
*
Yes
No
Please enter a Description, the Manufacturer Name and Value of each item.
*
Ex: Mini Excavator - Kubota - $34,000
Is there anything else you are concerned about insuring that was not listed in the questions above?
If you have any Photos or Policy Pages that you would like to upload for review please upload them here.
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Are You A Current MM Insurance Customer?
*
No
Yes
How Did You Hear About MM Insurance?
*
Customer Type
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