Hospitality Intake Form Designed

Commercial Insurance Quote

Please complete so we can obtain an accurate quote for your business. (For best results turn your phone sideways)
SECTION 1: General Information
Current insurance renewal?

MonthDayYear
Date of Renewal or Closing
Contact Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Location Details

	Company Name	DBA	Building Address	City	State	Zip Code
Buiding Location 1
Buiding Location 2
Buiding Location 3
Buiding Location 4
Buiding Location 5

SECTION 2: Property

Property Details 1:

	Building Limit	Contents Limit	Year Built	# of Rooms	# of stories	Square Footage	Sign Value
Buiding Location 1
Buiding Location 2
Buiding Location 3
Buiding Location 4
Buiding Location 5

Property Details 2:

	Gross Revenue	Gross Liquor Sales	Occupancy Rate %	Ave Daily Room Rate	Restaurant on Premises?	Swimming Pool?
Location 1
Location 2
Location 3
Location 4
Location 5

Property Details 3:

	Gross Payroll	Number of Full Time Employees	Number of Part Time Employees	Alarm System	Fire Sprinklers	Year Roof Updated	Year HVAC Updated
Location 1
Location 2
Location 3
Location 4
Location 5

Have you made any claims in the past 5 years?

YesNo

Have you made any claims in the past 5 years?

	Date of Claim	Type of Claim	Total $ of Claim
Claim 1
Claim 2
Claim 3
Claim 4

Thank you!

We will get back to you within one business day. Quotes can take from one day to 10 days depending on complexity.
Should be Empty: