Restaurant Insurance Page

RESTAURANT INSURANCE INSURANCE FORM


Contact Person :
Phone Number :	(xxx-xxx-xxxx)
Email Address :

Restaurant Name :
Address :
City :
State :
Zip :

Years in Restaurant Business :
Years Operating Restaurant :
Franchise :	Yes No
Hours of Operations :
Number of Employees :
Total Payroll :
Gross Annual Sales :
Alcohol Sold on Premises :	Yes No
Alcohol Percentage of Gross Sales :
Do you Deliver :	Yes No
Delivery Percentage of Gross Sales :
Do you Cater :	Yes No
Catering Percentage of Gross Sales :
Deep Fat Fryers :	Yes No
Open Flames :	Yes No
How Many Video Games :
How Many Pool Table :
How Many Dartboards :
Number of Bartenders :
Full-time Bartenders :
Part-time Bartenders :
Number of Servers :
Full-time Servers :
Part-time Servers :
Drink Specials :	Yes No

Number of Stories :
Roof type composition :
Roof Age :
Automated Sprinkler :	Yes No
Basement :	Yes No

Number of Vehicles to Insure :
Policy Effetive Date :
Policy Renewal Date :
Approximate Current Premium :
Current Insurance :
Claims in last three years :	Yes No
Bankruptcies or Tax Leins in past 5 years :	Yes No