Step 1 of 5
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Type of Insurance Interest |
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Federal ID# or SS# |
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Business Name |
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Year Business Started |
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Legal Entity/Status |
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Scope of Business |
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Owners of Business |
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Do you own the building |
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Is the building owner to be name as additional insured? |
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Number of years in business |
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Gross Annual Payroll |
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Gross Annual Revenue |
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Number of full-time employees |
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Number of part-time employees |
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Website |
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Landline Telephone |
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Have their been any claims over the last 5 years? |
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Are employee hiring procedures in place on application and employment manual for background checks, confidentiality agreement & non-piracy agreement? |
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