BUSINESS OWNER'S INFORMATION

First Name *

Last Name *

Phone *

Email *

BUSINESS INFORMATION

Legal Business Name

DBA (Doing Business As) Name

Federal or Tax Identification Number (FID or TIN)

Business Structure

Address

Street Address *

City

State

Country

Zip Code *

Total square footage of the restaurant within the building

Types of businesses occupying the same building

Business Phone Number

Business Email Address

Website

Year Business Established

RESTAURANT OPERATIONS

Type of Restaurant

Annual Gross Revenue

Estimated Annual Payroll

Number of Full-Time Employees

Number of Part-Time Employees

Operating Hours

Do you offer catering services?

Do you offer delivery services?

For deliveries, do employees use personal or company vehicles?

Do you have an outdoor dining area?

Do you have entertainment or live events?

Seating Capacity (Restaurant)

Seating Capacity (Bar / Lounge)

Do you provide valet parking?

Please specify location for valet parking, if applicable.

Do you hany any outstanding tax liens or bankruptcy?

Please explain any outstanding tax liens or bankruptcy, if applicable.

Do you have any citations for Health Board Violations?

Please explain any citations for Health Board Violations, if applicable.

LIQUOR SALES & LIABILITY

Does the restaurant serve alcohol?

Do you have Liquor License?

If yes, what type of license?

Percentage of Revenue from Alcohol Sales:

Do employees receive alcohol service training (TIPS, ServSafe, etc.)?

WORKER'S COMPENSATION & EMPLOYEE SAFETY

Do you have workers’ compensation insurance?

Do employees receive safety training?

Do you conduct background checks before hiring?

Any history of employee injury claims in the past 5 years?

BUSINESS INTERRUPTION & CYBER LIABILITY

Do you have a business continuity or disaster recovery plan?

Do you store customer payment information?

Do you have cybersecurity measures in place?

CLAIMS HISTORY

Any insurance claims in the past 5 years?

If yes pease provide details:

Date of Incident

Type of claim

Cause of Incident

Payout Amount

TYPE OF INSURANCE NEEDED

Desired Coverage Limits

Current Insurance Provider (if applicable):

Current Policy Expiration Date (if applicable)

FINAL STEPS

Preferred Contact Time

Preferred Contact Method

Additional Comments (Optional)

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Ranges
Ovens
Deep Fryers
Baskets
Char-Broillers
Flat Grills
Woks
Others