Commercial Property Intake Form

Commercial Property Insurance Intake Form
Which BIG Agent are you working with?
An Agent will be assigned if unlisted
Client Information
Owner Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Owner's Contact Info*

Phone NumberEmail
Business Name*
Entity Type*
LLC, S-Corp, LP, C-Corp, Joint Venture
EIN*
Year of Construction*
Date Property Acquired

MonthDayYear
Date
Years of Management Experience in the Industry
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
yesno
CallTextEmail
Number of Tenants
Total sqft:*
Sqft of Owner Occupied Space*
Occupancy Rate (%)
List of Tenants and Description of Business Operations and Products
Please upload pictures of the building.

Cancelof
Type of Construction
Type of Building
RoofElectric WiringHVACPlumbing
Updated Year
YesNo
YesNo
Annual Rental Income ($)
Please Upload Copy of Current Policy.

Cancelof
Current Insurance Carrier
Current Building Coverage ($)*
Current Annual Premium ($)
Current Liability Coverage ($)*
Current expiration date*

MonthDayYear
Date
Please let us know about any optional coverages that must be included.
Who referred you to BIG?
Referral info

First NameLast Name
Contact Info

Phone NumberEmail
Additional Interests / Lender Information
NAME / COMPANY
Certificate Holders (Owners, Landlords, Property Managers, etc)
What Happens Next?

Immediate Action: We begin working on the insurance quotes as soon as we receive this form completed.
Contact: Our office can be reached at +1(512)255-5555

Thank you for trusting us - we appreciate growing with everyone we interact with!
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Commercial Property Insurance Intake Form

Client Information

Who referred you to BIG?

Additional Interests / Lender Information