Commercial General Liability Quote Questionnaire
Please complete the form to ensure that we can best meet your insurance needs.
Email *
Name of Corporate Officer (s) *
Name of Corporate Entity *
Phone number *
Date you began or will begin operating your business? *
MM
/
DD
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YYYY
Date corporation officially established at the Secretary of State?
MM
/
DD
/
YYYY
Business Address *
Please provide Tax ID (EIN) number
Are you currently insured? *
If applicable, when will your coverage expire?
Have you had or do you currently have any claims pending against your company? *
How soon do you need coverage? *
Please provide an accurate description of the nature of your business. *
List any commercial vehicles you would like to insure along with the VIN number
Do you subcontract any work performed to outside vendors (1099 workers)? *
Will you need product liability insurance?  (This is for a proprietary, consumable product, or device). *
Will you hire W2 employees? *
Will you need Workers Compensation insurance? *
How much revenue did you generate last fiscal year? (If NONE right NONE). *
How much revenue do you expect to generate in this fiscal year? *
How much value of business personal property would you like to insure?  Include all equipment, and product inventory if applicable. *
How much annual business income would you like to insure if your business is non-operational due to a covered loss? *
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