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 listPhoneThis field is for validation purposes and should be left unchanged.
