Restaurant Insurance

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Why do you need it?

It covers you in case you become legally obligated to pay for damage to some else's property or pay for injury to a third party. It also pays your legal fees if you are wrongfully sued.

Liability Insurance Quote Form

Please fill out form as completely as possible. Fields with bold titles may not be left blank. All information is held in the strictest confidence.

Your Name:

Business Name:

Street Address:

City:

State:

Zip Code:

E-Mail:

Work Phone:

Home Phone:

Mobile Phone:

Fax:

Description of Your Restaurant:

Value of Building:

Value of Contents:

Total Square feet:

Square Footage of
Dining Room Area:

Year Built:

Value of food in Storage:

Do you Rent or Own the Building:

If you selected own,
do you Rent to others:

Yes

If so, how many square feet?:

Is there a basement?:

Do you have a burglar alarm?:

If yes, is it a Central Station
Alarm:

Name of Alarm Company:

Do you have a fire alarm?:

Who maintains it?:

Have you made any improvments
to the building?:

If yes, please tell us what
and when:

Distance from the nearest building:

Right: Left: Rear:

Annual Gross Receipts:

Annual Payroll:

Number of years in Business:

Alchohol Service:

Gross Sales From Alchohol Bev.:

Desired Deductable:

Current Insurance Carrier:

Current Policy Number:

Policy Expiration Date:

Please prioritize your request:

I need it now, please quote ASAP!

Please quote prior to my renewal

No hurry, just checking

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