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Business Owner's Quote

Name:
  
Business Name:
Business Phone:
Business Fax:
Email:
Mailing Address:
Mailing Address (Suite#):
County:
Insured Address  (If different):
Insured Address (Suite#):
County:
Insured Business Name (If different):
Year Constructed:
Ground Floor Square Footage:
Construction Type:
Are there smoke & fire alarms on all levels of the property?:
Do you have...
Dead Bolt Locks?   yes   no
Fire Extinguishers?   yes   no
Do you have a burglar alarm system?:
Is there a fire hydrant within 1000 feet of your property?
yes   no
How many miles to the fire department?
Type of Heat?
If oil, where is the tank located?
Do you have a woodburning stove?
yes   no
If yes, was it professionally installed?
Do you have a swimming pool?
yes   no
If yes, is it fenced in with a locking gate?
Present Insurance Company:
Renewal Date:
Have you filed any businessowners claims in the last three years?
yes   no
If yes, please describe the claim and amounts paid out:
If the building is over 20 years old, list the year when the following systems were last updated?
Roof:
Heat:
Plumbing:
Electrical:
Current Coverage Amount:
Building:


Contents:


Loss of Income:


Liability:


Medical Payments:


Products Completed by Workers:


Fire Legal Liability:


Personal & Advertising Injury:


Accounts Receivable:


Computer (Hardware/Software):


Employee Benefits:


Employee Dishonesty:


Fine Arts:


Money & Securities:


Non-Owned/Hired Auto:


Valuable Papers/Records:


Water Damage/Sewer Backup:


Deductible:


Current Annual Premium:


Would you like coverage for...

Sinkhole Collapse:
yes   no

Earthquake:
yes   no

Law or Ordinance:
yes   no

Please email us your questions, comments or feedback. If your question concerns an existing policy, please provide the respective policy or account number for faster processing.

If you question is concerning a specific quote, please provide as much information as possible for an accurate quote.

Saucon Mutual Insurance Company | 528 North New Street, Fourth Floor, Bethlehem, Pennsylvania 18018
E-mail: info@sauconmutual.com | Telephone 610- 868-1800 | Fax 610-317-0998
 
Copyright © 2007 Saucon Mutual Insurance Company All Rights Reserved.