Commercial Insurance Quote Request - BJJ Gym. 
My name is Chris Martin and I am the founder of JiuJitsuInsurance.com and I will be the sole person working on generating the insurance quotes for your small business. As a personal insurance broker I take the heavy lifting of shopping for your insurance quotes off of your plate. As a niche business we are laser focused on serving the needs of the growing Jiu Jitsu community. That said, I can narrow down the best options for your school based on the information you provide below. Rest assured I am not going to sell your information to any third parties, the below information is for my records only. After reviewing your information I will recommend the best program for the activities at your academy. If you have any questions you can call me at 224-505-1888. (npn #7335986)
Sign in to Google to save your progress. Learn more
Commercial Insurance Quote Request - BJJ Gym.
Your Name:  *
Your Email: *
Your Phone Number:
Name of insured (as will appear on policy): 
Type of operation 
Clear selection
Policy Mailing Address (street, city, state, zip):
Location Address  (street, city, state, zip)::
Policy Effective Date:
MM
/
DD
/
YYYY
Has the facility had more than $7500 in claims within the past 3 years? 
Clear selection
Does your facility include any of the following activities? 
Do you have a waiver system for participants?
Clear selection
Do you need equipment insurance? 
Clear selection
Does your Landlord have requirements for coverage? If so, can you describe what they need from you? 
What is the monthly head count for ADULTS martial arts students (estimate if you are  a start up school)?
What is the monthly head count for KIDS martial arts students (estimate if you are  a start up school)?
Are you planning to host any in house tournaments or scrimmages with outside schools? 
Clear selection
Will you offer birthday parties at your school? 
Clear selection
Do you have any coaches (teaching at your school) that are 1099 employees? 
Clear selection
Do you have a boxing ring or Mma cage?  *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Benefit Awareness.

Does this form look suspicious? Report