Get Started We’re glad you’ve taken the next step towards a peace of mind with insurance. Please fill out the multi-step form below as best as possible. Require fields are marked with an asterisk. 1Business Information2Operations3Property Your Name* First Last Phone*Email* Legal Business Name & DBA* Year Started* MM slash DD slash YYYY Entity Type* Mailing Address* Mailing (Apt., Suite, etc.) Location Address* Location (Apt., Suite, etc.) Policy Exp. or Start Date MM slash DD slash YYYY File or Scan of Your Expiring PolicyAccepted file types: doc, docx, pdf, Max. file size: 25 MB.Expiring policy Number & Insurance CompanyAny losses? If so when and how much?Entertainment Devices*(pool table, darts, video games) Pool Table Darts Video Games Pull Tabs Video Lottery None Live Music? Yes No How many days per month? Days & Hours of Operation* Dance Floor Yes No If dance floor, how large (approximately)? Happy Hour Time, Type of DiscountCollege Campus Within 2 Miles? Yes No Maximum Legal Occupancy* Number of Part Time Staff vs. Full Time Staff* Part Time Full Time Any Liquor Violations?* Yes No Avg. Price for Beer*Avg. Price for WineAvg. Price for LiquorGross Sales: AlcoholGross Sales: FoodNet Sales: Gambling/Video PokerNumber of Pull Tab Tanks or Video Lottery Payroll*EPLI – Coverage desired?Covers for sexual harassment, discrimination, wrongful termination suits brought on by employees. Yes No Maybe Own or Rent Building?* Own Rent Square Footage* Year Built* Construction Type of Building* Year of Property Updates?1980-19891990-19992000-20092010 +AmountBuilding coverage needed? Yes No Limit?Burglar & Fire Alarm? Yes No Connected to a Central Fire/Police Station? Yes No Not Sure Business IncomeDo you want net sales and ongoing expenses reimbursed during time of construction if something catastrophic happens to the building(s)? Yes No If so, what monthly amount of net income and ongoing expenses? Surveillance Camera(s)? Yes No Fakes BPP – Contents Coverage LimitWhat is the total cost to replace kitchen, stock, seating, TVs, etc? Any Other Notes?I Confirm I Am Human* Confirmed CommentsThis field is for validation purposes and should be left unchanged.