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
DBA
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?
 Yes
 No
If you use subcontractors, do you keep a copy of their certificate?
 Yes
 No
Do you use a written contract with your subcontractors?
 Yes
 No
Number of employees, including owner:
Your estimated payroll:
Do you own any of the following that we do not insure:
 Autos
 Buildings
 Contents
 Tools/Equipment
 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