| Underwriting Information |
| What is the nature of your business? |
Nature of Business
|
| Is the business a corporation, partnership or sole proprietorship? |
Corporation
Partnership
Sole Proprietorship |
| How many owners? |
Number of Owners |
|
| How many employees? |
Number of Employees |
|
| What is the payroll amount of the owners? |
Payroll of Owners |
|
| What is the payroll amount of the employees? |
Payroll of Employees |
|
| What is the total annual gross? |
Total Annual Gross Receipts |
|
| What is the business license number? |
Business License Number |
|
| What is the license type? |
License Type |
|
| Years of experience in this business? |
Years of Experience |
|
| How many years have you operated under your current business name? |
Years Operated Under Current Name |
|
| Have you used any other business names during the past 5 years? |
Other Business Names |
Yes No |
| Is this business open 24 hours a day |
Open 24 Hours |
Yes No |
| Any deep frying (food)? |
Deep Frying |
Yes No |
| Is there any manufacturing, mixing, re-labeling or repackaging of products? |
Manufacturing |
Yes No |
| Is there filling of propane tanks? |
Propane Tank Filling |
Yes No |
| Please describe the nature of your business and ANY unusual exposures. |
Unusual Exposures
|
