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Restaurant Quote Form


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Insurances interested in
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Company Owner
First Name
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Last Name
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Primary Phone Number
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Alternate Phone Number
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E-Mail Address
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Company Information
Company Name
Required
Business Type
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FEIN
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Street
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City
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State / Province
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ZIP / Postal Code
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Year Business Established
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Operations
Number of Employees
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Gross Annual Sales
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Annual food sales receipts($)
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Annual liquor sales receipts ($)
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Annual catering/banquet sales receipts ($)
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Hour of operation (open)
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Hours of operation (closing)
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Please check all that apply
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Seating capacity
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Emergency Lighting
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Cooking devices
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Hold down the Ctrl Key to make multiple selections.
UL 300 Approved Automatic Extinguishing System
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If yes then = Ul 300 Approved System Wet or Dry
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Automatic Gas or Electric Shut offs for Cooking
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Property Coverage
Occupancy
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Estimated Cost of Building Replacement
Optional
Year Built
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Construction Type
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Square Footage of Location
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Roof Type
Optional
Number of Stories Including Basement
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Business Personal Property Limits
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Current Information
Current Insurance Provider
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Current Policy End Date
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/ /
Claims/Property Losses in Past 5 Years (Please Explain)
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Workers Compensation
Restaurant payroll ($)
Optional
Office payroll ($)
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Outide sales payroll ($)
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Additional Comments
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How did you hear about us?
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Submission Validation
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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