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Policy Review

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Policy Review

Client Information

First Name *
Last Name *
Email *
Phone Number *
What insurance do you currently have with us? *
Company Name *

Company Address

Street Address *
Address Line 2
City *
State *
ZIP Code *
Total Annual Sales *
Total Number of Employees *

Your Business Structure

Please think back over the last year when answering these questions.

Have you changed the ownership structure of your business? *
Have you added new or changed your existing operations and/or products? *
Have you begun to buy supplies or sell your products overseas? *
Are you operating out of any new locations or have you closed locations? *
Please Explain any changes to your business structure.
Please do not include sensitive, private information in this area.

Your Personal Liability

Please think back over the last year when answering these questions.

Have you acquired, leased or sold a building, business property and/or equipment? *
Have there been any improvements and/or significant alterations to your building? *
Has your inventory level changed significantly? *
Have you purchased, leased or sold any Vehicles? *
Please Explain any changes to your personal liability.
Please do not include sensitive, private information in this area.

Your Income Protection

Please think back over the last year when answering these questions.

Have your Businesses revenues changed by more than 10% since last year? *
Do you rely on a single supplier for more than 50% of your materials? *
Do you rely on a single buyer for more than 50% of your sales? *
Please Explain any changes to your income protection.
Please do not include sensitive, private information in this area.

Your Employees & Professional Liability Exposure

Please think back over the last year when answering these questions.

Do you have employees that regularly travel out of state or overseas for business? *
Do any employees use their own personal cars for business purposes? *
Do any Employees work outside your home state or work from their home regularly? *
Do you obtain Certificate of Insurance from all subcontractors, vendors and 1099 workers? *
Are any of the owners a member of any board of directors whether for profit or not? *
Please Explain any changes to your employees and personal liability exposure.
Please do not include sensitive, private information in this area.

Additional Protection

Need additional insurance? Just let us know how we can help.

Would you like to discuss any additional insurance protection with our firm? *

Confirmation

Confirmation