Current Insurance
Do you have business insurance now?		Yes No	If yes, with what company?		How many years have you had coverage? (With no lapse)
Have you had any claims within the last 3 years?		If so, please provide details:
Property Information
Do you own or lease?	Select One Own Lease	How long have you been at this location?		What is the appraised property value?
How many floors?		What is the square footage?		What type of construction?	Select One Wood Frame Brick/Masonry Veneer Steel Other
What percentage of the building has sprinklers?		Type of parking?	Private Lot Public Lot Garage Street None Other	Does the property have a pool?	Yes No
If so, is the pool fenced?	Yes No	Is there a day care center on premise?		Yes No
Is there a security system?	Yes No	Is the Building located within 1000 Feet of a fire hydrant?		Yes No
Business Income
Gross business income			Other income
Policy Coverage
How much liability coverage?	Select One $100k $300k $1 million $2 million Other	What is the preferred deductible?	Select One $250 $500 $1k $2.5k $5k Other
Please provide any additional information you feel is pertinent to the insurance