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Business Insurance




When you are busy running your business, you don't have time to worry about your insurance coverage. We make it easy for you to run your business without the worry of what might happen.


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Business Information

Name of Insured Business Phone Number Cell Number Email Address
Name of Business Risk Address Mailing Address (if different from Risk Address)

Is this business incorporated? YesNo

If yes, name of the incorporation:

Nature of the business, please describe in detail.

How many years have you been operating this business or a similar business?

Any claims in the last 5 years? YesNo

If yes, please explain.

Do you currently have insurance? YesNo

Name of your insurance company:

Why do you not currently have insurance?

Do you rent or lease space? YesNo

Landlord's Name Landlord's Phone Number
Number of Employees Annual Revenue Hours of Operation

Cope Details

Square Feet Occupied:

Construction type:

How old is the building/unit?

Does the unit have a sprinkler system? YesNo

Do you have a monitored alarm system? YesNo

Is the alarm system for fire, burglary, or both? FireBurglaryBoth

Name of Alarm Company:

Do you have other security in your building/unit? YesNo

If yes, please describe:

Coverage Required

Total value of all business personal property
Total value of all computers in the business
Liability Coverage required
Leasehold Coverage required
Any special coverage required?

Any other details you would like to add?