Please fill out the following questionnaire
as completely as possible. Remember, the more accurate the information
is, the more accurate the quote will be
Date
Referred
By:
Current Carrier(if any):
Expiration
Date:
Owners Name/Legal Entitiy:
Property
Address:
Mailing Address:
email:
Phone:
Fax:
Business Operations: (i.e. restaurant, etc.)
Square Feet:
Number of stories:
Building Construction Type:
Roof Construction Type:
Exterior Fountains: No Yes
Value:
Building Limit: (if known)
Palapa:
Signs / Description:
Contents Limit:
Theft w/Violence:
Glass Limit:
Money & Securities:
Earthquake:
No Yes
Please provides us with your comments here:
General Liability: $1,000,000 (Standard) Lower Limits
Available
RFC # / Factura Information: Need Copy of RFC Card
