| Professional Classification: |
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Describe IN Brief DETAIL,
Your Profession and Business Operations:
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*
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Examples
Accountant, Real-estate
Agent, Nurse, Attorney. Executive Title, (etc) |
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| Payroll Data: |
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List Employee's
Annual Payroll Here (if none, enter $0):
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*
$ |
Insert # of Employees here if any :
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*
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| Coverage
Desired: (Check One Please) |
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The Coverage I Am Looking For: * |
General ( E & O) Liability Only
Liability & Business Contents
Liability, Building
& Contents Coverage
A Package Policy Including the
Above,
Plus Miscellaneous Coverage. |
| Location & Sales
Information: |
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Insert Annual Gross Revenues
from this occupation here:
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*
$
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Square Footage of office or business location :
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If Building Coverage needed, Enter Type
(wood frame, concrete, etc.):
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Number of Stories
( If Applicable)
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If you are not exactly sure about coverage
type... we will suggest the best coverage for you - just try to tell us what you
are looking for in Comments / Remarks. (If we need more info. we will let you
know.)
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Only choose those coverage's
that you need |
Professional Liability
Coverage:
($300,000, $500,000, $1 Million, etc.)
| $*
| If E & O or Liability
Only. Skip from Here to Comments and Submit. |
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Tenants Liability
Coverage:
($300,000, $500,000, $1 Million, etc.)
| $*
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Leased
Building Space. Tenants Lease required Liability. If none, Skip to next. |
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Business Contents
Coverage:
(The amount of your personal business
property if any)
| $*
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If No
Contents required. Skip to next. |
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Building Coverage:
(If Any, The amount of building coverage if you own your bldg.)
| $*
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Owned
Property. If Not Owned. Skip from Here to Comments and Submit. |
Miscellaneous Coverage:
(List any special coverage peculiar to
your profession.) |
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