New Business Questionnaire New Business QuestionnaireNamed Insured:FEIN:Entity Type:Mailing Address:Location Address:Owner Name:Contact name:Email PhoneYear established:Years Experience:Previous carrier:Loss runs?Dec Pages?Estimated Sales:Estimated Payroll:How many jobs per year?Tract Homes?Description of Operations:General LiabilityDescription:Sales/Payroll:Residential %Commercial %Does the applicant hire subcontractors? Yes No Sub Costs:Work CompDescription:Sales/Payroll:Owners:Included/Excluded:Number of Employees:Is Property Coverage Needed?Address Street Address City State / Province / Region ZIP / Postal Code Building limit:BPP Limit:Year Built:Sq FT:Construction type:# of Stories:Is Business Auto Coverage Needed? Yes No Vehicle ListYearMakeModelVIN Add RemoveClick the "+" icon to add items in the listDriver ListNameDOBDL # Add RemoveClick the "+" icon to add items in the listIs Umbrella Coverage Needed? Yes No Limit:Is Inland Marine Coverage Needed Yes No ListYearMakeModelSerial #Limit Add RemoveClick the "+" icon to add items in the listEmailThis field is for validation purposes and should be left unchanged.
