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Additional Locations-Supplement - Busn Policy Qte Request


Use this form for additional locations  after completing the Business Policy form for location one.  Address requested is the location address.

First Name
Required
Last Name
Required
Location Number
Optional
Type of Location
Required
Street
Required
City
Required
State / Province
Required
ZIP / Postal Code
Required
# of Additional Insureds
Optional
Annual Gross Sales
Required
% of Sales from Retail
Optional
% of Sales from Wholesale
Optional
% of Sales from Home Delivery
Optional
% of Sales from Fire Restoration
Optional
Storage - Max. Limits
Optional
Number of Employees
Optional
Business Personal Property Limits
Required
Building Limits
Optional
Type of Solvent
Required
Haz Waste Hauler - Name
Optional
Sign - Attached Outside Sign Value
Optional
Value of Outside Awning (if any)
Optional
Sign- Detached Outside Sign Value
Optional
Age of Building
Required
Age of Boiler
Required


Hold down the Ctrl Key to make multiple selections.
Age of Cleaning Machine
Required


Hold down the Ctrl Key to make multiple selections.
Square Footage of Your Occupancy
Required
Construction Type
Required
Number of Stories
Required
Burglar Alarm - Central Monitor
Optional
Fire Alarm - Centrally Monitored
Optional
Sprinkler System
Optional
Roof - Updates or Replacement - Year
Optional
Electrical Updates - Year
Optional
Plumbing Updates - Year
Optional
Type of Business on both sides (if in attached blding)
Optional
E-Mail Address
Required
Free Standing Location or Attached (eg. strip)
Required
Number of Stories
Optional
Occupancy Rate
Required
Additional Comments
Optional
Submission Validation
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

Per the terms of our online privacy policy we will not resell your information to any third-party.
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