United American Insurance Center: Business Owners


BUSINESS OWNERS PACKAGE (BOP) INSURANCE QUOTE	We would like to provide you with a free, no-obligation Business Insurance Quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

GENERAL INFORMATION

Name of Insured:

Address:

City:

State:

Zip:

Phone:

Fax:

Email Address:

Location Address:

City:

State:

Zip:

PROPERTY QUESTIONS

Year Building was Built:

Type of Building Construction:

Number of Stories:

Other Occupancies:

Square Feet You Occupy:

If the building is over 25 years old, please answer the following:

Year Electricity was Updated:

Is it on Circuit Breakers:

Year Plumbing was Updated:

Copper or Galvanized Plumbing:

Year of Last Re-roofing:

Type of Roofing Material:

Type of Heating System:

PROTECTIVE DEVICES

Burglar Alarm:

Type of Alarm:

Alarm Company:

Sprinkler System in Building:

Smoke Detectors:

LIABILITY QUESTIONS

Previous Carrier:

Policy Number:

Prior Premium:

Policy Renewal Date:

BUSINESS INFORMATION

Years in Business:

Projected Gross Annual Receipts:

Projected Annual Payroll:

Describe your Business, Products, or Services: