Commercial Property
  About Your Company
 
Company Name* :
Your First Name* :
Last Name* :
Email* :
Email address (retype)* :
Street Address* :
City* :
Select State* :
Zip* :
Phone (Day)* :
Phone (Evening) :
Fax :
     
When would you like to be contacted? : No Preference Morning
Afternoon Evening
     
 
About Your Business
Sole Proprietorship Partnership Corporation LLC Association
Do you currently have Commercial Property insurance? : Yes No
    If "Yes", when does your current policy expire?
   
    If "Yes," who are you currently insured with?
   
Do You Own, Lease, or Rent the Business Location? :
Number of years at Location :
If property is owned, please describe the occupancies :
Approximate Year Property was Built :
Total Square Footage of Location :
Updates (If you are the tenant, please guestimate)
Roof : (Enter year last updated)
Electric : (Enter year last updated)
Heating : (Enter year last updated)
Plumbing : (Enter year last updated)
Alarms
Burglar Alarm : Central Station Local None
Fire Alarm : Central Station Local None
Sprinklered?   Yes No    
Amount of Building Coverage Desired :
Amount of Contents Coverage Desired :
Replacement Cost (RCV) or Actual Cash Value (ACV)? : RCV ACV    
Is Loss of Rents or of Business Income desired? : Yes No    
If Yes, amount to include: (annual figure)
   
Preferred Deductible :
$ 500 $ 1000 $ 1500 $ 2500
$ 5000 Other        
Has your company had any claims in the last 3 years? : Yes No
    If "Yes", briefly explain:
   
Any Comments / Questions? :