Convenience Store Quote
Fields marked (
*
) are mandatory.
General Information
Named of Corp:
DBA name:
Property Address:
Mailing Address if different:
Current policy carrier
Policy #
Claims
Building free studing/strip canter
With/without property
with
without
Property value $
Sq ft
Is there any restaurant near property?
No
Yes
24 HRS?
No
Yes
Car wash?
No
Yes
Deli within store?
No
Yes
Year Built
Building :
Brick
Metal
Frame
Joist masonry
Protection class if known
Type of Burglar/fire alarm
central
local
no alarm
Building sprinklered?
No
Yes
canopy value $
MPD's
Pumps value $
Inventory value $
Out side sales in gallons/month
Inside sales/moth $
No.of employees FT and PT
Annual Payroll $
For workman comp
Policy #
Current company
Claims