Commercial New Client Information Form

Hello & Welcome!

Northshire Insurance is happy to serve your Commercial Insurance needs!
Legal Name of Business:*
What type of business are you trying to insure?*

Sole ProprietorshipPartnershipLimited Liability Company (LLC)CorporationS CorporationNonprofit Organization (NPO)Cooperative (Co-op)FranchiseOther (explain in comments section)
What type/types of commercial insurance are you looking for?*

General Liability InsuranceCommercial Property InsuranceCommercial Auto InsuranceWorkers' Compensation InsuranceProfessional Liability InsuranceProduct Liability InsuranceCyber Liability InsuranceEmployment Practices Liability Insurance (EPLI)Umbrella/Excess Liability InsuranceOther (explain in comments section)

Owner Information*

Company or Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (If Different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Number*
E-mail*
example@example.com
Employer Identification Number (EIN) or SS# for Sole Proprietorship*
Please fill out to the best of your knowledge...

If your just starting, estimate as close as possible. If not applicable type N/A
How many employees do you have? *
What is your expected annual payroll cost?*
Do you use Sub-Contractors?*

YesNo
How much do you expect to pay all of your subcontactors together annually?*
What is your company's gross (before payroll & other expenses) income?*
Company website or Facebook Page (underwriters will look, so we need to):*
Referred By?
Do you currently have insurance?*

YesNo
Current Company
General discription of operations:
Commercial Auto Insurance:

If Commercial Auto insurance is needed please fill out the boxes below

Drivers Information

Please do your best to answer the following questions (feel free to send screenshots or pdf files of current Insurance Cards and Coverages in a separate Email or Text to save time)

Vehicle Info

Vehicle VINs (not mandatory but helpful)

Current Coverages (this may be easier over the phone or w/screenshots)

Other Insurances Needed?

HomeownersRentalCondoPersonal AutoUmbrellaOther (explain in comments)
Upload Files Here (screen shots, registration pics, past coverage, ect)

Cancelof
Comments or any other information you feel will help?
Should be Empty:

Hello & Welcome!