Review Form

Reviewing and updating your insurance program is an important part of protecting your business assets. We’ve developed a review questionnaire to trigger changes that have occurred. The purpose of the form is to make sure your insurance program is up to date with your business.
Legal name of your business
Who is in charge of Insurance?
Business phone
Mobile phone
Email address
Mailing address
Location address (if different)
Business Entity
 Indiv  Corp  LLC  Partnership  Other  
Fed Tax ID (FEIN)
Describe your business.
Do you own or operate any other business?
List the states in which you operate.
Your estimated sales:
If you had an extensive loss at your business location, what expenses would you have to keep your business running?
Do you use sub-contractors?
If you use subcontractors, do you keep a copy of their certificate?
Do you use a written contract with your subcontractors?
Number of employees, including owner:
Your estimated payroll:
Do you own any of the following that we do not insure:
 Other (describe)
Please list any concerns you have about your business insurance.

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move