Which best describes your business? *

Retail (I sell products to people)

Restaurant (I prepare and serve food or drinks)

Service (I provide service to customers)

Contractor (I build, repair, or service things)

Office (I run a business in an office setting)

Landlord (I rent or lease properties to others)

How is your business structured? *

Choose one

Registered business name *

I'd like to add a DBA name (doing business as) *

Yes

DBA Name

What does your business do?

Address

Business street address *

Country

Enter your country

State

City

Postal Code

Your company's website (optional)

What year was your business established?

What date do you want your policy to start?

As a small business owner, which of the thoughts below are relevant to your business?

What happens if someone gets hurt on my property or due to my products?

What if my tools or inventory get lost, stolen, or damaged?

How would I manage if an unexpected event stops my business?

What would happen if an employee was injured or was harmed at work?

Can I afford the cost of maintaining my business?

Do you currently have business insurance? *

Yes

Current Insurance Company

Policy Expiration Date

How much are you currently paying for insurance with your current carrier? (optional)

Please upload current policy/declarations pages (optional)

Click to upload

Does your business own or rent this location? *

Own

Rent

What type of location is your business based out of?

Commercial condominium

Commercial building

Personal residence

Number of units within building

What percentage of the building is vacant or unoccupied?

20%

40%

60%

80%

100%

Tell us about your building

What best describes the buildings construction? *

I'm not sure

Frame (made mostly of wood)

Joisted masonry (brick or concrete walls with wood framing inside)

Non-combustible (constructed of metal or steel)

Masonry non-combustible (brick or concrete walls with a non-combustible roof)

Is the building fully sprinklered? *

Yes

Total building sq feet

List the year of any renovations to the property below (optional)

Roof
Electrical
Plumbing
Heating

Enter your business personal property value ($) *

How much would it cost to replace the things you use to do business? (Include inventory)

Employee Details

How many owners, LLC members and executive officers do you have?

Do you have any employees working for your business? *

Yes

Not counting owners how many employees do you have? *

FEIN (A FEIN is required for us to issue your policy online but optional for quote)

Employee #1 Job Title & Role

Job Position or Duty
Annual Payroll Amount
# of Full Time Employees
# Part Time Employees

Employee #2 Job Title & Role

Job Position or Duty
Annual Payroll Amount
# of Full Time Employees
# Part Time Employees

Employee #3 Job Title & Role

Job Position or Duty
Annual Payroll Amount
# of Full Time Employees
# Part Time Employees

Employee #4 Job Title & Role

Job Position or Duty
Annual Payroll Amount
# of Full Time Employees
# Part Time Employees

Almost done! How can we reach you?

Great job! You've provided the necessary information for a preliminary quote. To get a better rate tailored to your business, would you like to spend a few more minutes sharing additional details?

Select an option

The owners of the business are on site and involved in the daily operations:

True

False

Provide additional details regarding the owners being on site and their involvement.

The management team has little turnover:

True

False

Provide additional details regarding the management team's turnover.

There are regular safety meetings: daily/weekly/monthly

True

False

Provide additional details regarding safety meetings.

There are formal hiring practices in place:

True

False

Provide additional details regarding the formal hiring practices in place (what are they?)

There is a formal employee training program in place:

True

False

Provide additional details regarding formal employee training (what is in place today?)

Employees obtain unrequired but beneficial additional certifications or industry education credits:

True

False

Provide additional details regarding employee certifications or credits.

The average employee tenure is better than average:

True

False

How long is the employee tenure?

The average years of industry experience per employee is:

Do you have equipment on a scheduled routine maintenance contract:

True

False

Provide additional details regarding the specific equipment on a scheduled routine maintenance contract.

Is video surveillance present?

True

False

How many cameras and how is the property monitored?

I would be willing to submit photos of any safety signs that are posted in and around the business?

True

False

First Name *

Last Name

Phone *

Email *

Please provide the name of the agent that shared this form with you. *

If unknown, please type "N/A"

We have a full suite of insurance solutions available to our customers and bundling insurance products can often provide additional discounts. Please let me know if you would like to discuss any of the following:

Tax free retirement income

Life insurance solutions for employers and their employees

Home owner, condo unit owner, or renters insurance

Auto insurance (business and/or personal)

Motorcycles, boats, RVs, etc.

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