BUSINESS PAGE QUESTIONAIRRE
Please answer a few questions in order to get you started.
Name
Email Address
Business Name
Years in Business
Street Address
City
State
Zip
Phone
Number of Owners
Number of Losses in past three years
How many locations do you have
Gross Annual Income
Number of Employees
Do you own the building you are in?
Yes
No
Describe your business (ten words or more).
What type of coverage do you need?
Liability
Property
Professional Liability
Worker’s Compensation
What is the value of your Business Property?
Do you work from home?
Yes
No
What is the square footage of your business?
How old is the building you are in?
What company do you have your insurance with now?
What is your estimated annual premium?
Do you have any further information that makes your business special?
Thank You. An agent will contact you shortly to verify this information and determine what market is best for you or you can contact us directly at (562)404-6166 or (714)562-9216 or email us at thatinsuranceguy@yahoo.com