Restaurant Insurance Quote Request

Please fill out the form below, once completed and submitted a representative will be in contact with you within the next business day.

First Name :* Last Name :*         Phone :*         E-mail Address :*         Best Time to call : AM PM

Business Name :*

Address :* City :* State : * Zip :* County :

Do you have any other locations other than listed above : Yes No Business Web Site : Nature of Business/ Description of Operations : Legal Entity : Select one S-Corporation C-Corporation LLC Sole Proprietorship Partnership Years in business : * Years of experience :* Current Insurance Carrier : * Policy # :* Premium :*$ From : * To : * Has any coverage for this operation been declined, cancelled or non-renewed in the last 3 years? * Yes No Why?*   Property : Building Coverage : * Building Deductible :* Building Owned or Leased : * Select one Owned Leased Business Personal Property : * Property Deductible : * Loss of Income : * ALS Monthly Indemnity $  Number of Stories : * Select one 1 2 3 4 5 Total Square Footage of Building :* Total Square Footage you occupy :* Basement : * Yes No Finished : Yes No %  Finished Electrical :* Circuit Breakers Fuses Fire Alarm :* Yes No Burglar Alarm :* Yes No Is building equipped with an automatic sprinkler system :* Yes No Smoke Detectors :* Yes No Carbon Monoxide Detectors :* Yes No General information : Years under current ownership : Years you have been in business at this location : Is business being conducted at this time : Yes No Do you do any deliveries? Yes No Hours of Operation :* AM PM To AM PM Total sales receipts for Food :* $ Do you serve alcohol? * Yes No Total Sales of Alcohol :* $ Do you do any Catering :* Yes No Total Catering (Sales) :* $ Is kitchen equipped with a UL 300 System : Yes No Is all cooking equipment protected by an automatic extinguishing system? Yes No Any entertainment?* Yes No If yes, select the type : * Select one Live Bands Disc Jockey Piano Exotic Dancing Other Frequency of entertainment : * Any Special Events? Describe : Is dancing permitted?* Yes No Total area of dance floor : * sq feet   Horseshoe Pits Baseball Volleyball Boat Docks Additional Interests : Loss Payee Mortgagee If yes, please list provider : Comments :