(717) 632-1216 McSherrystown, PA

Business Quote-Test

Business Quote

* = Required Field
General Information
Contact Name *
Email *
Phone Number *

Business Name/Legal Name
Business Location Address
Zip/Postal Code*
Business Phone
Fax #
Business Information
Number of years in business
Number of Years in this profession  
Annual Gross Sales (or projected if new in business)  
Number of full-time employees  
Number of part-time employees  
Annual payroll  
Number of locations  
Brief description of your business & clientele

Seating capacity (if restaurant or pub)  
Cost of any subcontracted work  
Location/Premises InformationAddress

Current Coverages

Business Information
# of Full-Time Employees
# of Part-Time Employees
How long in Business? (yrs)
How many locations?
Please give a brief description of your business and clientele
Property/Premises Information
Occupancy Status  
Year Built
% Occupied
Construction Type
# Basements
Sq. Footage
Burglar Alarm  
Building Value
Other Property (specify)
Insurance Information
Annual Gross Sales: (before taxes)
Number of Employees
Annualized Payroll
Cost of any Subcontracted Work
Limits Requested

Describe any claims you've had in the past 5 years
Additional Comments
* = Required Field