Commercial Building Insurance

COMMERCIAL BUILDING INSURANCE FORM


Contact Person :
Phone Number :	(xxx-xxx-xxxx)
EmailAddress :
Type of Building :	Apartment Warehouse Strip Mall Office Other
Type of Business :	Sole Proprietor Corporation Partnership LLC
Building Address :
City :
State :
Zip :
Mailing Address :
City :
State :
Zip :
Fax Number :	(xxx-xxx-xxxx)
Building Value :	$
Building Contents Value :	$
Business Income Value :	$
Number of Units :
Building Square Feet :	Square Feet
Number of Stories :
Basement :	Yes No
Number of Swimming Pools :
Does the building have Copper Wiring :	Yes No
Year Built :
Construction Type :	Masonary Masonary N/C Frame
Is there an automated sprinkler :	Yes No
Have you reported any claims or losses to your insurance company within the last 3 years :	Yes No
Roof type composition :
Roof Age :	years
Current Insurer :
How long have you been insured with this company :	years
Policy Renewal Date :
Approximate Current Premium :	$
Amount of Coverage :	$
Deductible :	$