Commercial Fast App

Commercial Fast App
Name of Business*
Website*
How did you find us?*

ReferralGoogleSocial MediaOther
Referred By*

First NameLast Name
Referral Source*
First Point of Contact*

First NameLast Name
Office Number*
First Point of Contact
Mobile Number*
First Point of Contact
Email*
First Point of Contact
Desired Effective Date*

MonthDayYear
Date
How Many Owners?*

1st Owner Details
Name*

First NameLast Name
Percentage of Ownership*
Email*
example@example.com

2nd Owner Details

3rd Owner Details

4th Owner Details

5th Owner Details

Start of Property
Commercial Property
How many locations do you own or lease?*

Location 1
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is this a Condo?*

YesNo
Occupancy*

OwnerTenant
Monitored Alarm*

LocalMonitoredNone
Sprinklered*

YesNo
Building Value*
Tenant Improvements and Betterments*
Business Personal Property*
Square Feet*
How many stories?*
Year Built*
Construction Type/Material*
Roof Type*
For the questions below, please enter the estimated year that each of them was updated
Year Roof Updated*
Year Electric Updated*
Year Plumbing Updated*
Year HVAC Updated*

Location 2

Location 3

Location 4

Location 5

End of Locations
Commercial Property Additional Notes

Start of Auto
Commercial Auto
Driver Details
Do you have a Driver List file available for upload?*

YesNo
Driver List*

Cancelof
How many drivers do you have?*

Driver 1
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
License Number*
Licensed State*
CDL?*

YesNo

Driver 2

Driver 3

Driver 4

Driver 5

Vehicle 1
Year*
Make*
Model*
VIN Number*
Radius*
Trailer Length (If Applicable)
Garaging Zip Code of Vehicle*
Value of Vehicle*
Permanently Attached Equipment Value (If Any)

Vehicle 2

Vehicle 3

Vehicle 4

Vehicle 5

End of Vehicle
Commercial Auto Additional Notes

Start of Workers Compensation
Workers Compensation
Owner Details
Number of Owners*

Owner 1
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Title*
*Note: If you choose to exclude the owner from Worker's Comp benefits, they must be at least 25% owner
Duties*
Ownership Percentage*
Exclude?*

YesNo

Owner 2
*Note: If you choose to exclude the owner from Worker's Comp benefits, they must be at least 25% owner

Owner 3

Owner 4

Owner 5

End of Owner Details
Does your business have a documented Safety Program?*

YesNo
Safety Program Documents*

Cancelof
Employee/Payroll Details

*Note: Employee Category Examples: Clerical, Driver, Technician, Retail, Electricians, HVAC, Plumbers, Artisan Contractor
List the Employee Category, Number of Employees, and Payroll Category Total*
One category per line
Workers Compensation Additional Notes

Start of Errors and Omissions
Errors and Omissions
Limits of Liability*
Errors and Omissions Additional Notes

Start of Cyber
Cyber
Limits of Liability*
Cyber Additional Notes

Start of Directors and Officers
Directors and Officers
Limits of Liability*
Directors and Officers Additional Notes

Start of Inland Marine
Inland Marine
Inland Marine Schedule - Mobile
Do you have an equipment list to upload?*

YesNo
Equipment List*

Cancelof
List Item Description, Serial Number, Make/Model, and Item Value*
One item per line. Schedule any item values at $500 or more
Total Estimate Value of Misc. Tools/Equipment under $500*
Inland Marine Additional Notes

Start of Crime
Crime
Limits of Liability*
Crime Additional Notes

Start of Umbrella
Umbrella
Limits of Liability*
Deductible*
Umbrella Additional Notes

Start of Group Health
Group Health
Company Desired Coverrages*

Major MedicalDentalVisionLifeShort Term DisabilityLong Term DisabilityOther Ancillary Coverages
Other Ancillary Coverages Types*
1. Download a copy of the Group Health Census Form.

2. Fill it up with the necessary details

3. Once completed, upload it below
Group Health Census Form Upload*

Cancelof
Group Health Additional Notes

Start of Builders Risk
Owner Name*

First NameLast Name
Builder Name*

First NameLast Name
Are you the owner or contractor?*

OwnerContractor
Property Location Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How many buildings are at this location?*

Building 1
Cost of Labor*
Cost of Materials*
Construction Type*
Roof Type*
Number of Stories*
Square Feet*

Building 2

Building 3

Building 4

Building 5

End of Buildings
Inside City Limits?*

YesNo
Distance to Fire Hydrant*
Distance to Fire Station*
Remodeled or New Construction?*

RemodeledNew Construction
Pre-Construction Value*
Year of Original Construction*
Description of Renovations*
Has Construction Begun?*

YesNo
Construction Start Date*

MonthDayYear
Date
Expected Completion Date*

MonthDayYear
Date
Flood Needed?*

YesNo
Mortgage Company
Builders Risk Additional Notes

Start of Cargo
Limits of Liability*
Cargo Additional Notes

Start of Bond
Type of Bond*
Bond Amount*
Bond Additional Notes

End of Form
Should be Empty:

Commercial Fast App

Coverage Requested

Commercial General Liability

Commercial Property

Commercial Auto

Workers Compensation

Errors and Omissions

Cyber

Directors and Officers

Inland Marine

Crime

Umbrella

Group Health