Business Insurance Quote Form - Britton and Britton Insurance

Is this a home-based business?*
Date of Birth*
MM slash DD slash YYYY
FEIN/Tax ID Number*
Business Owner’s Home Address*
Street Address Address Line 2 City State ZIP Code

Note: Primary address of businessowner is required by underwriting and will not be used for correspondence.
Please describe*
Are clients or employees permitted in your home or residence?*
Is this business or property currently insured?*
What is the expiration date?
MM slash DD slash YYYY
Did your prior policy cancel or non-renewal in the past 5 years?*
If so, why?*
Have there been claims in the past 5 years?*
If yes, please describe including date and amount paid out:*

General Liability?
Business owner policy (BOP)?
Liability Amount
Number of principle owners*
Please enter a number from 1 to 100.
Estimate annual gross sales or revenue*
Estimate annual payroll employees*
Does the landlord or another entity need to be listed as additional insured?*
Please request “Loss Runs” from your current insurance provider. Underwriting will require these to confirm claim history and provide quotes or apply premium discounts. Loss Runs can be e-mailed to info@brittonandbritton.com
Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Phone*
Please describe any contract requirements:
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Is this business a golf course or country club?
Is this business a restaurant?*
Is this business a food truck or food trailer?*
Golf Course Questions
Is the Golf Club:*
Estimate Annual Sales from Member dues and initiation fees*
Estimate Annual Sales from Green fees, cart fees, other*
Estimate Annual Sales from HOA Fees*
Estimate Annual Sales Pro-Shop (if owned)*
Do you need coverage for the HOA?*
Number of Rounds played/year (include non-members):*
Number of members:*
Number of employees (full time)*
Number of employees (part time)*
Number of golf carts:*
Number of other carts (beverage, range cart)*
Describe any other amenities or activities (such as Guest Quarters, Fitness Center, Pool, Tournaments):*
Restaurant Questions
Estimate Annual Sales Food Sales*
Estimate Annual Sales Liquor Sales*
Estimate Annual Sales Catering Sales*
Estimate Annual Sales Delivery Sales*
Describe any live entertainment, happy hours, promotions or specials*
Food Truck/Trailer Questions
Year / Make / Model*
Vehicle ID (VIN), Serial or Model Number*
Length of Food Truck/Trailer*
Value of Food Truck/Trailer*
Value of permanently installed kitchen and equipment*
How often will the Food truck or trailer be moved per month?*
Will you serve alcoholic beverages?*
Disclaimer: By submitting this form you agree to the collection of your personal data pursuant to our privacy policy.

Business, Property or Liability Insurance

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Golf Course Questions

Restaurant Questions

Food Truck/Trailer Questions