(If yes, list carrier, and # of years continuous. If none, type NONE)
(If none, type NONE)
(proprietorship, corporation, etc.)
(i.e., Delicatessen and sandwich shop, etc.)
Ownership & Payroll Data
Location & Sales Information
NOTE: Don't worry if you are not exactly sure about coverage type... we will suggest the best coverage for you - just try to tell us what you are looking for! (If we need more info. we will let you know.)
($300,000, $500,000, $1 Million, etc.)
(The amount of your personal business property)
(The amount of building coverage if you own your bldg.)
(List any special coverage peculiar to your business, such as Garagekeepers Legal, Loss of Earnings, Valuable Papers, etc.)
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