Business Insurance Questionnaire Quote

Business Insurance Quotation Form

Any questions please feel free to contact our office at 770-472-1800 or info@pearsonconsultinggroupllc.com
Agent
Choose the Agent You are Working With
Name

First NameLast Name
Date of Birth
E-Mail
Email
Phone Number

Area CodePhone Number
Company Name
Company Name
Entity Type
Year Business Started
Employer Identification Number (EIN/Tax ID)
Description of Operations/Describe Your Business
Years in Business (If new startup, years of experience)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name and Policy Number of Current Insurance Carrier
If No prior, type None
Building Information Required
Own or Rent Building
Year Built
Year Updated
If no updates to Roof, Plumbing, Electrical, type None
Number of Stories
Construction Type: Brick, Frame, Siding, Etc.
Occupancy Square Footage
Total Square Footage
Insurance Coverage

Insurance Coverage Needed
Insurance Coverage You are Interested In (Check All That Applies)

Other
Amount of Property Coverage Needed (Tools, Equipment, etc.)
Estimated Annual Revenue/Sales
Number of Full-Time Employees
Number of Part-Time Employees
Estimated Yearly Payroll
Do You Use Subcontractors?
If you Use Subcontractors, what is your total annual subcontractor cost?
If No, type N/A
List Information (Name, verbiage, address, etc.) for all Additional Insured or Certificate Holder Requirements for a Lease or Contract
If None, Type N/A
Attach a Copy of Contract or Requirements for Additional Insured or Certificate Holder Requirements

Browse Files
If Available, attach a lease agreement or contract with a company that is requiring to be listed as an Additional Insured or Certificate Holder Cancelof
Attach Current Dec Page

Browse Files

Cancelof
Attach Current Loss Runs

Browse Files
Unavailable, request from your current insurance carrier Cancelof
Should be Empty:

Business Insurance Quotation Form

Building Information Required

Insurance Coverage