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Operation Information Description of Operation:
Annual Receipts................. Annual Payroll.................... Type of Business................ ..... Sole Properrity Parntership Corporation Number of Full Time Employees................ Number of Part Time Employees................ Location of Business: Address...... City............. State Zip
Business Occupancy....... Office Retail Storage Construction.................... Frame or Masonry
Value of Building (if owned)..... Value of Contents.................. Value of Tools & Equipment....
Loss History (List all losses in last three years)
Select if none Date........Description.........Amount
Have you had previous insurance? Yes No If yes, how many years?......... When does it expire?..............
Comments
Please Note: Insurance coverage cannot be bound without a written binder from our office.
Please Note: Insurance coverage cannot be bound without a written binder from our office. Additionally, Please Note: Many insurance carriers use information gathered from you and outside sources about your claim, driving and credit history. This information allows insurance companies to determine accurately the proper price to charge. You are entitled to a free copy of the reports by contacting the appropriate consumer reporting agency within the next 60 days. By filling out this quote you agree to the the above terms.
