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Getting Started with Business Insurance

Please make sure you fill out everything to the best of your knowledge as everything affects carrier choice and premium cost. Thank you, Philip Miles / CA Lic# 0K93165 AZ Lic# 17963684
When do you need coverage to start?

MonthDayYear
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 NameLast Name
Date of Birth
Cell Phone #

Area CodePhone Number
Email
example@example.com
What type of entity are you?
Legal Entity Name
What is your F-EIN number?
If none, please skip.
Business Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your mailing the same as your business address?
What is the location of the business?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Tell Us About Your Business
Describe how your business makes money and/or it's purpose:
What is the reason you are searching for a new policy with us?
Examples: Current cost went up to....., New business, Past policy lapsed on...., Need just general liability, need a full business owners policy, Need workers comp etc.
Business Website:
If you have a DBA, what is it?
What year did you start your business?
E.G. 2007
How many years of experience do you have in this industry?
In this specific industry you need coverage for
Is your business currently insured with an active policy?
Does your business own any structures or buildings?
What year was your building built?
As close as you can to the date as this is a rating factor
Building Square footage you occupy
As close as you can estimate
What is the builiding you occupy construction type?
E.G. Wood frame, Masonry, Steel
To best of your knowledge what year was the plumbing updated?   Year*
To best of your knowledge what year was the electrical updated?   Year*
To the best of your knowledge what year was the roof updated?   Year*
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?
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?
Current Quotes

Cancelof
Do you have any cars that are registered to the business?
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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Should be Empty:

Getting Started with Business Insurance

Business Owner Contact Information

Tell Us About Your Business