"*" indicates required fields
Thank you for your interest in receiving a business insurance quote. This form should only take about 5-10 minutes to complete. Don't worry if you don't have everything. You can always click the "Save and continue later" button below. We'll email you a private link to pick up where you left off.
If you do not have either, or operate using your Social Security Number, please enter "none".
This should be the physical address of your business. No PO Boxes please.
If you sell a product enter your total annual sales.
If you provide a service enter your total business income.
If you're business is new and you do not have any business income yet, please enter what you estimate your first year's sales/income will be.
This is how much you pay your subcontractors, gross, per year.
Example: For contractors this could include roofing, plumbing, electrical, foundation pouring, etc.
Example: For real estate brokers this would include your agents.
Example: For janitorial this could include other cleaners, landscapers, etc.
Its best for us to review the lease to make sure the insurance quotes are in accordance with your lease requirements. (Some leases require the tenant to insure the glass in the building, name the landlord as Additional Insured, and will list the required liability limits)
This would be upgrades to the inside of your unit such as flooring, walls, built-ins, etc.
This is your office space, not the total square footage of the building.
If you are don't know when the roof was last updated just enter "unsure".
If you are don't know when the plumbing was last updated just enter "unsure".
If you are don't know when the electrical was last updated just enter "unsure".
Examples include: Social security numbers, credit/debit cards, account number, health care records, personal information, etc.
• Acceptable Use Policy• Backup & Retention Policy• Data Security Policy• Incident Response Policy• Network Security Policy• Risk Assessment & Management Policy• SDLC & QA Policy• Third Party Security Policy
If you don't have a security policy in place just enter "none".
This also includes information which is on mobile devices, transmitted wirelessly, or transmitted over public networks, and encryption of non-employee full Social Security and full credit card numbers.
Example: Office equipment, computers, furniture, tools (that stay at the business location), or other items used for your business.
This section requires the following information for all owners and employees: Name, Birthdate, Drivers License Number and License State, Employment Type (full or part time), and if the business provides the person with a vehicle.
We understand it may take some time to gather all this information. Please just be aware that we will need this information in order to submit to the insurance companies for a quote. Your agent will contact you to go over this.
List the percentage of the work you provide for each section below.
Type(s) of work performed (in percent). Total must equal 100%.