* indicates a required field
* Your Name:
Bus. Location - Street:
Town:
*Zip:
Additional Locations:
* Your Company Name:
* Email:
Website Address:
Phone Number:
Best Time to Call: Morning Afternoon Evening
Brief Description of Business:
Size of Building:
Owner / Tennant:
Central Alarm System: Yes No
Value of Contents:
Any Food Sales: Yes No
Construction of Building: Frame Masonry Steel Combination
Area You Occupy:
Sprinkler System: Yes No
Age of Building:
# of Stories:
# of Members:
# Years in Business:
Estimated Annual Payroll:
# Boats Stored in Racks:
Swimming Pool: Yes No
# Years Experience:
# Boat Slips:
# Owned Boats:
# Tennis Courts:
If you serve food
Estimated Annual Receipts for
Valet Parking: Yes No
Total Annual Receipts:
Kitchen Extinguishing System: Wet Dry
Catering Receipts:
Liquor Receipts:
Slip Rental:
Winter Storage:
Fueling:
Hauling & Launching:
Boat / Motor / Accessories Sales:
Repairs:
Lessons:
All Other Receipts:
Number of Business Automobiles :
Current Insurance Company:
Date Current Policy Expires:
Any Claims in the Past Three Years?: Yes No
Home | Business Insurance | Personal Insurance | About Us | Carriers | Contact Us | Career Opportunities Testimonials | Real Estate Services | Site Map | Links | Privacy Policy © Anderson Insurance Agency, 2007. All Rights Reserved.
