business_owner

Quick Response Form:

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For immediate quotes and coverage explanation call: 1-800-921-1008 Ext 111, William Fleischer • Email: Wfleischer@bfbond.com

BUSINESS OWNER QUESTIONNAIRE

Please, fill out the form completely

Applicant Name

Phone Number

Fax Number

Business Name

Email

Business Address

State

Is Mailing Address same as Business Address?

Yes No

Mailing Address

State

Years in Business

Experience in Field

Years at location

FEIN or Social Security#

Business Personal Property Limit

Cost of Improvements

Personal Property Limit

Annual Income

Year Built

Construction

# of Stories

Type of Roof

Building updates including your space

Electrical

Plumbing

Heating

Roof

Smoke Detectors?

Yes No

Fire Alarm?

Yes No

Burglar Alarm?

Yes No

Central Station?

Yes No

Fire Extinguishers?

Yes No

Roll Down Gate?

Yes No

Closest Fire Hydrant

Other Occupants in Building

Square feet you occupy

Any product(s) sold or repackaged under your company name?

Yes No

# of Owners

# of Full Time Employees

# of Employees Part Time

Payroll

Food Gross Receipts

Liquor/Beer Gross Receipts

Office Hours

# of Days

Current Insurance Company:

Current Premium

5 Year Loss History

Any Bankruptcy?

Yes No

Current Liability Limit

Additional Insured

Additional Insured Full Name

Address

State

Other relevant information